Levothyroxine compositions having unique triidothyronine plasma AUC properties

ABSTRACT

The present invention generally relates to stable pharmaceutical compositions, and methods of making and administering such compositions. In one aspect, the invention features stabilized pharmaceutical compositions that include pharmaceutically active ingredients such as levothyroxine (T4) sodium and liothyronine (T3) sodium (thyroid hormone drugs), preferably in an immediate release solid dosage form. Also provided are methods for making and using such immediate release and stabilized compositions.

RELATED U.S. PATENT APPLICATIONS

[0001] This application for U.S. patent claims priority to the followingU.S. provisional applications, each of which was filed on Aug. 14, 2001:Serial No. 60/312,114 and is entitled Methods of AdministeringLevothyroxine Pharmaceutical Compositions; Serial No. 60/312,113 and isentitled Levothyroxine Compositions Having Uunique Triiodothyronine CmaxProperties; Serial No. 60/312,287 and is entitled LevothyroxineCompositions Having Unique Triidothyronine Plasma AUC Properties; SerialNo. 60/312,184 and is entitled Levothyroxine Compositions Having UniqueCmax Properties; Serial No. 60/312,273 and is entitled LevothyroxineCompositions Having Unique Tmax Properties; Serial No. 60/312,206 and isentitled Levothyroxine Compositions Having Unique Triiodothyronine TmaxProperties; Serial No. 60/312,289 and is entitled Unique LevothyroxineAqueous Materials.

U.S. PATENT APPLICATION

[0002] This application for U.S. patent is filed as a utilityapplication under U.S.C., Title 35, §111(a).

[0003] 1. Field of the Invention

[0004] The invention generally relates to stable pharmaceuticalcompositions, and methods of making and administering such compositions.In one aspect, the invention features stabilized pharmaceuticalcompositions that include pharmaceutically active ingredients such aslevothyroxine (T4) sodium and liothyronine (T3) sodium (thyroid hormonedrugs), preferably in an immediate release solid dosage form. Alsoprovided are methods for making and using such immediate release andstabilized compositions.

[0005] 2. Background

[0006] Thyroid hormone preparations of levothyroxine sodium andliothyronine sodium are pharmaceutical preparations useful to thetreatment of hypothyroidism and thyroid hormone replacement therapy inmammals, for example, humans and dogs.

[0007] Thyroid hormone preparations are used to treat reduced or absentthyroid function of any etiology, including human or animal ailmentssuch as myxedema, cretinism and obesity.

[0008] Hypothyroidism is a common condition. It has been reported in theUnited States Federal Register that Hypothyroidism has a prevalence of0.5 percent to 1.3 percent in adults. In people over 60, the prevalenceof primary hypothyroidism increases to 2.7 percent in men and 7.1percent in women. Because congenital hypothyroidism may result inirreversible mental retardation, which can be avoided with earlydiagnosis and treatment, newborn screening for this disorder ismandatory in North America, Europe, and Japan.

[0009] Thyroid hormone replacement therapy can be a chronic, lifetimeendeavor. The dosage is established for each patient Individually.Generally, the initial dose is small. The amount is increased graduallyuntil clinical evaluation and laboratory tests indicate that an optimalresponse has been achieved. The dose required to maintain this responseis then continued. The age and general physical condition of the patientand the severity and duration of hypothyroid symptoms determine theinitial dosage and the rate at which the dosage may be increased to theeventual maintenance level. It has been reported that the dosageincrease should be very gradual in patients with myxedema orcardiovascular disease to prevent precipitation of angina, myocardialinfarction, or stroke.

[0010] It is important that thyroid hormone treatment have the correctdosage. Both under-treatment and over-treatment can have deleterioushealth impacts. In the case of under-treatment, a sub-optimal responseand hypothyroidism could result. Under-treatment has also been reportedto be a potential factor in decreased cardiac contractility andincreased risk of coronary artery disease. Conversely, over-treatmentmay result in toxic manifestations of hyperthyroidism such as cardiacpain, palpitations, or cardiac arrhythmia's. In patients with coronaryheart disease, even a small increase in the dose of levothyroxine sodiummay be hazardous in a particular.

[0011] Hyperthyroidism is a known risk factor for osteoporosis. Severalstudies suggest that sub clinical hyperthyroidism in premenopausal womenreceiving thyroid hormone drugs for replacement or suppressive therapyis associated with bone loss. To minimize the risk of osteoporosis, itis preferable that the dose be kept to the lowest effective dose.

[0012] Because of the risks associated with over-treatment orunder-treatment with levothyroxine sodium, there is a need for thyroidhormone products that are consistent in potency and bioavailability.Such consistency is best accomplished by manufacturing techniques thatmaintain consistent amounts of the active moiety during tabletmanufacture.

[0013] Thyroid hormone drugs are natural or synthetic preparationscontaining tetraiodothyronine (T₄, levothyroxine) or triiodothyronine(T₃, liothyronine) or both, usually as their pharmaceutically acceptable(e.g. sodium) salts. T₄ and T₃ are produced in the human thyroid glandby the iodination and coupling of the amino acid tyrosine. T₄ containsfour iodine atoms and is formed by the coupling of two molecules ofdiiodotyrosine (DIT). T₃ contains three atoms of iodine and is formed bythe coupling of one molecule of DIT with one molecule ofmonoiodotyrosine (MIT). Both hormones are stored in the thyroid colloidas thyroglobulin. Thyroid hormone preparations belong to two categories:(1) natural hormonal preparations derived from animal thyroid, and (2)synthetic preparations. Natural preparations include desiccated thyroidand thyroglobulin.

[0014] Desiccated thyroid is derived from domesticated animals that areused for food by man (either beef or hog thyroid), and thyroglobulin isderived from thyroid glands of the hog. The United States Pharmacopoeia(USP) has standardized the total iodine content of natural preparations.Thyroid USP contains not less than (NLT) 0.17 percent and not more than(NMT) 0.23 percent iodine, and thyroglobulin contains not less than(NLT) 0.7 percent of organically bound iodine. Iodine content is only anindirect indicator of true hormonal biologic activity.

[0015] Synthetic forms for both T₄ and T₃ thyroid hormone are availablefrom a number of producers. For example, liothyronine sodium (T₃)tablets are available under the trademark Cytomel® from KingPharmaceuticals, Inc., St. Louis, Mo. Levothyroxine sodium (T₄) isavailable under the tradename Levoxyl® from King Pharmaceuticals, Inc.,under the tradename Synthroid® from Knoll Pharmaceutical, Mt. Olive,N.J., and under the tradename Unithroid® from Jerome StevensPharmaceuticals, Bohemia, N.Y. In addition a veterinarian preparation oflevothyroxine sodium is available under the tradename Soloxine® fromKing Pharmaceuticals, Inc.

[0016] Levoxyl® (levothyroxine sodium tablets,USP) contain syntheticcrystalline L-3,3′,5,5′-tetraiodothyronine sodium salt [levothyroxine(T₄) sodium]. As indicated above, the synthetic T₄ in Levoxyl® isidentical to that produced in the human thyroid gland. The levothyroxine(T₄) sodium in Levoxyl® has an empirical formula of C₁₅H₁₀ I₄ NNaO₄.H₂O, molecular weight of 798.86 g/mol (anhydrous), and a structuralformula as shown:

[0017] It is well known that the stability of thyroid hormone drugs isquite poor. They are hygroscopic and degrade in the presence of moistureor light, and under conditions of high temperature. The instability isespecially notable in the presence of pharmaceutical excipients, such ascarbohydrates, including lactose, sucrose, dextrose and starch, as wellas certain dyes. The critical nature of the dosage requirements, and thelack of stability of the active ingredients in the popularpharmaceutical formulations, have led to a crisis which has adverselyeffected the most prescribed thyroid drug products. See, e.g., 62 Fed.Reg. 43535 (Aug. 14, 1997).

[0018] It is desirable, therefore, to prepare a stabilized dosage oflevothyroxine and liothyronine, which will have a longer shelf life thatcan be used in the treatment of human or animal thyroid hormonedeficiency. U.S. Pat. No. 5,225,204 (the '204 patent) is directed toimproving the stability of levothyroxine sodium. In one embodimentdisclosed by '204, stabilized levothyroxine sodium was prepared in a drystate by mixing levothyroxine sodium with a cellulose tableting agentusing geometric dilution and subsequently combining this mixture withthe same or a second cellulose tableting agent, such as microcrystallinecellulose. Other tableting aids or excipients can be used in thisformulation. This '204 patent is incorporated by reference herein, inits entirety.

[0019] The microcrystalline cellulose disclosed In '204 is AVICEL 101®,AVICEL 102®, AVICEL 103®, AVICEL 105®, trademarks of FMC Company ofNewark, Del., and Microcrystalline Cellulose NF, or EMCOCEL®, atrademark owned by Penwest Pharmaceuticals of Patterson, N.Y. Thesemicrocrystalline cellulose products are prepared by re-slurrying thecellulose and spray drying the product. This produces an α-helixspherical microcrystalline cellulose product.

[0020] U.S. Pat. Nos. 5,955,105 and 6,056,975 (the continuation of '105)disclose pharmaceutical preparations of levothyroxine andmicrocrystalline cellulose, along with other excipients. Themicrocrystalline cellulose products used in the '105 and '975 patentswere also the α-form Avicel microcrystalline cellulose products. U.S.Pat. Nos. 5,955,105 and 6,056,975 are incorporated by reference herein,in their entirety.

[0021] Another microcrystalline cellulose product is a β-sheet formmicrocrystalline cellulose having a flat needle shape, marketed underthe trademark CEOLUS KG801® by FMC Company of Newark, Del. The Ceolus®product has different morphology, and different performancecharacteristics, than those of the Avicel product. The β-sheetmicrocrystalline cellulose of the present invention is disclosed in U.S.Pat. No. 5,574,150, which is hereby incorporated by reference. Furtherdisclosure relating to β-sheet microcrystalline cellulose is found inInternational Journal of Pharmaceutics 182 (199) 155 which is herebyincorporated by reference.

[0022] The Ceolus® product (β-sheet microcrystalline cellulose) isdisclosed by FMC, in its product bulletin dated October 1997, as beingsuitable for “smaller size tablets” and “exceptional drug carryingcapacity.” The Ceolus® product was said to provide superiorcompressibility and drug loading capacity, that still exhibitedeffective flowability. The examples given in the Ceolus® bulletin wereof vitamin C combined with Ceolus® microcrystalline cellulose at levelsof from 30 to 45 weight % Ceolus® product in the form of a tablet.

[0023] However, there have been problems using the Ceolus® product. Forexample, at higher levels of Ceolus® product concentration, flowproblems were encountered in the process of compressing tablets, and theCeolus® product was considered unsuitable for compression at higherconcentrations than about 45 weight %.

[0024] The is a definite need for solid levothyroxine (T4) and/orliothyronine (T3) (thyroid hormone drugs) pharmaceutical compositions,preferably in an immediate release solid dosage form, with the T4 and T3in the form of their sodium salts that are relatively stable. There isalso a need for methods for making such immediate release and stabilizedsolid levothyroxine (T4) and/or liothyronine (T3) (thyroid hormonedrugs) pharmaceutical compositions.

SUMMARY OF THE INVENTION

[0025] The present invention overcomes and alleviates theabove-mentioned drawbacks and disadvantages in the thyroid drug artthrough the discovery of novel oral levothyroxine (T4) and/orliothyronine (T3) (thyroid hormone drugs) pharmaceutical compositionsand methods.

[0026] Generally speaking, the present invention relates to stabilizedsolid as levothyroxine (T4) sodium and/or liothyronine (T3) sodium(thyroid hormone drugs) pharmaceutical compositions and in particular,immediate release, stabilized pharmaceutical compositions that includepharmaceutically active ingredients such as levothyroxine (T4) sodiumand/or liothyronine (T3) sodium (thyroid hormone drugs). Preferably butnot necessarily, the novel pharmaceutical compositions are provided in asolid dosage form, such as a tablet.

[0027] The pharmaceutical compositions of the present invention areuseful for, among other things, as replacement or supplemental therapyin hypothyroidism of any etiology, except transient hypothyroidismduring the recovery phase of subacute thyroiditis, suppression ofpituitary TSH secretion in the treatment or prevention of various typesof euthyroid goiters, including thyroid nodules, Hashimoto'sthyroiditis, multinodular goiter and, as adjunctive therapy in themanagement of thyrotropin-dependent well-differentiated thyroid cancerin warm-blooded animals, especially humans including pediatrics.

[0028] The present invention also provides methods for making suchimmediate release and stabilized levothyroxine (T4) sodium and/orliothyronine (T3) sodium (thyroid hormone drugs) pharmaceuticalcompositions.

[0029] Also in accordance with the present invention, because of theextraordinary release characteristics of the preferred compositions, amethod of administration to children and patients who have difficultytaking pills, wherein the solid composition having the appropriatedosage is simply put in an aqueous fluid, e.g., juice, where itdissolves in a matter of 1-3 minutes, and the patient can then ingestthe fluid, and receive the appropriate dosage, is now made practical.

[0030] The present invention has a wide range of important usesincluding providing pharmaceutically active levothyroxine compositionswith enhanced bioavailability, improved shelf life, and more reliablepotency.

[0031] We have discovered immediate release pharmaceutical compositionsthat include as pharmaceutically active ingredients at least one oflevothyroxine and liothyronine, preferably at least one levothyroxinesalt, as the major active ingredient. Such preferred immediate releasecompositions desirably provide at least about 85% (w/v) dissolution ofthe levothyroxine salt in less than about 20 minutes as determined bystandard assays disclosed herein. Surprisingly, it has been found thatby combining the pharmaceutically active ingredients with specificadditives in accordance with the invention, it is possible to formulatethe compositions so that the ingredients are released almost immediatelyafter ingestion or contact with an aqueous solution, e.g., in a matterof minutes. Preferred invention compositions are stable and providebetter shelf life and potency characteristics than prior pharmaceuticalcompositions.

[0032] The immediate release pharmaceutical compositions of theinvention provide important uses and advantages. A major advantage isthe stability of the active ingredients in the composition. For example,while, as indicated above, prior formulations with sugars, starches, andvarious types of celluloses, including micro-cellular celluloses such asthe Avicel products, have experienced substantial degradation of theactive ingredients, e.g. T4 sodium. To deal with this problem,pharmaceutical manufacturers have over-formulated the T4-containingpharmaceutical compositions containing such active ingredients, so thatthe patient can obtain at least the prescribed dosage despite thecarbohydrate-induced instability of the active ingredient. However, thepatient who obtains the pharmaceutical immediately after it is made,receives an over-dosage of the active compound; whereas, the patient whohas received the pharmaceutical after it has sat on the pharmacy shelffor an extended period, will receive an under-dosage of the activeingredient. In either case, the patient receives the wrong dosage, withpossible serious consequences.

[0033] In sharp contrast, it has been surprisingly found that the use ofthe β-sheet microcrystalline cellulose in the compositions of thepresent invention substantially increase the stability of the thyroidhormone drugs, so that the patient obtains consistent potency over anextended shelf life, compared to prior thyroid hormone drug products. Inthis application, the term “stabilized”, as applied to levothyroxineand/or liothyronine means that the loss of potency over the shelf lifeof the product is less than about 0.7% potency per month, for at leastabout 18 months. Preferred compositions have a loss of potency of lessthan about 0.5% per month for such a period, and more preferredcompositions have a loss of potency of less than about 0.3% per monthfor such a period.

[0034] Further, the compositions of the invention provide favorablepharmacokinetic characteristics when compared to prior formulations. Inparticular, the immediate release pharmaceutical compositions thatinclude levothyroxine salt have are more quickly available forabsorption by the gastrointestinal (GI) tract faster and are absorbedmore completely than has heretofore been possible. This inventionfeature substantially enhances levothyroxine bioavailability, therebyimproving efficacy and reliability of many standard thyroid hormonereplacement strategies.

[0035] Additionally, the desirable immediate release characteristics ofthe present invention facilitate dosing of patients who may be generallyadverse to thyroid hormone replacement strategies involving soliddosing. More specifically, immediate release pharmaceutical compositionsdisclosed herein can be rapidly dissolved in an appropriate aqueoussolution (e.g., water, saline, juice) or colloidal suspension (e.g.,baby formula or milk) for convenient administration to such patients.Illustrative of such patients include infants, children, and adults whomay experience swallowing difficulties. The invention thus makesstandard thyroid hormone replacement strategies more flexible andreliable for such patients.

[0036] Accordingly, and in one embodiment, the invention features animmediate release pharmaceutical composition comprising at least onelevothyroxine salt, preferably one of such a salt. At least about 80% ofthe levothyroxine dissolves in aqueous solution in less than about 20minutes as determined by a standard assay, disclosed herein. Preferably,at least about 80% of the levothyroxine is dissolved in the aqueoussolution by about 15 minutes from the time that the composition, in pillform, is placed in the aqueous solution. More preferably, at least about85% of the levothyroxine is released to the aqueous solution by about 10minutes, most preferably by about 5 minutes after exposure of thecomposition to the aqueous solution. As shown below, compositions inaccordance with the present invention can be formulated to release 85%of the levothyroxine within 2-3 minutes after exposure to the aqueoussolution.

[0037] It has been found that by combining one or more of thepharmaceutically active agents with β-form microcrystalline cellulose,it is possible to produce compositions with favorable immediate releasecharacteristics. Without wishing to be bound to theory, it is believedthat the agents do not bind well to certain grades of the β-sheet formmicrocrystalline cellulose. More of the agent is thus available forimmediate release. In contrast, it is believed that many priorformulations have active agents that bind cellulose additives, makingless available. The release characteristics of the compositions of theinvention are also improved by the use of other agents, as discussedfurther below.

[0038] Thus in one embodiment, the present invention relates to astabilized pharmaceutical composition comprising a pharmaceuticallyactive ingredient, such as levothyroxine, and the β-sheet form ofmicrocrystalline cellulose, in the form of a solid dosage. Morespecifically, the present invention relates to a stabilizedpharmaceutical composition comprising a pharmaceutically activeingredient, such as levothyroxine sodium and/or liothyronine sodium, atleast about 50 weight % of the dosage weight composed of the β-sheetform of microcrystalline cellulose, and, optionally, additionalexcipients, in a solid dosage form.

[0039] In another aspect, the invention provides an aqueous solution orcolloidal suspension that includes at least one of the compositions ofthis invention, preferably between from about one to about five of same,more preferably about one of such compositions.

[0040] It has also been found that β-sheet microcrystalline cellulosegrades having preferred bulk densities provide for more compactprocessing than use of other celluloses. That is, use of the β-sheetmicrocrystalline cellulose having bulk densities in accord with thisinvention helps to provide for higher compression ratios (initialvolume/final volume). As discussed below, other invention aspects helpreduce or avoid production of damaging compression heat that has damagedprior formulations made from high compression ratios. The compositionsof the present invention generally also require less compressional forceto form the tablets.

[0041] Accordingly, the invention also provides methods for making animmediate release pharmaceutical composition comprising at least onelevothyroxine salt, preferably one of such a salt. In one embodiment,the method includes at least one and preferably all of the followingsteps:

[0042] a) mixing a levothyroxine salt with microcrystalline β-celluloseand preferably a crosscarmellose salt to make a blend; and

[0043] b) compressing the blend in a ratio of initial volume to finalvolume of between from about 2:1 to about 5:1 to make the composition,preferably about 4:1.

[0044] In one embodiment, the method involves preparing an oral dosageform of a pharmaceutically active ingredient comprising dry blending thepharmaceutically active ingredient and at least about 50 weight % of theβ-sheet form of microcrystalline cellulose, and compressing the blend toform a solid dosage.

[0045] These and other objects, features, and advantages of the presentinvention may be better understood and appreciated from the followingdetailed description of the embodiments thereof, selected for purposesof illustration and shown in the accompanying figures and examples. Itshould therefore be understood that the particular embodimentsillustrating the present invention are exemplary only and not to beregarded as limitations of the present invention.

BRIEF DESCRIPTION OF THE FIGS.

[0046] The foregoing and other objects, advantages and features of theinvention, and the manner in which the same are accomplished, willbecome more readily apparent upon consideration of the followingdetailed description of the invention taken in conjunction with theaccompanying Figs., which illustrate a preferred and exemplaryembodiment, wherein:

[0047] FIGS. 1A-1C illustrate various solid dosage forms such ascylindrical tablets and raised violin shaped tablets;

[0048]FIG. 2 illustrates a tableting die pair;

[0049]FIG. 3 pair; is graphical depiction of comparative dissolutiondata of various strengths of Levoxyl® tablets made in accordance withthe invention.

[0050]FIG. 4A is an HPLC chromatogram showing a levothryoxine andliothyronine standards.

[0051]FIG. 4B is an HPLC chromatograph showing results of levothyroxinesodium sample made in accordance with the present invention.

[0052]FIG. 5A is a chromatogram showing various levothryoxine impuritystandards.

[0053]FIG. 5B is a chromatograph showing results of levothyroxine sodiumsample made in accordance with the present invention.

DETAILED DESCRIPTION

[0054] By way of illustrating and providing a more complete appreciationof the present invention and many of the attendant advantages thereof,the following detailed description is given concerning the novel orallevothyroxine (T4) and/or liothyronine (T3) (thyroid hormone drugs)pharmaceutical compositions and methods for use in warm-blooded animals,especially humans and children.

[0055] As discussed, the invention relates to immediate release solidpharmaceutical compositions such as stabilized pharmaceuticalcompositions that include pharmaceutically active ingredients such aslevothyroxine (T4) sodium and liothyronine (T3) sodium (thyroid hormonedrugs), preferably in a solid dosage form. Also provided are methods formaking such immediate release and stabilized compositions.

[0056] Aspects of the present invention have been disclosed in U.S.Provisional Application No. 60/269,089, entitled StabilizedPharmaceutical and Thyroid Hormone Compositions and Method ofPreparation and filed on Feb. 15, 2001 by Franz, G. A. et al. Thedisclosure of said provisional application is incorporated herein byreference.

[0057] By the phrase “immediate release” is meant a pharmaceuticalcomposition in which one or more active agents therein demonstrates atleast about 80% (w/v) dissolution, preferably between from about 90%(w/v) to about 95% (w/v), more preferably about 95% (w/v) to about 99%(w/v) or more within 15 to 20 minutes as determined by a standarddissolution test. Suitable standard dissolution tests are known in thefield. See FDA, Center for Drug Research, Guidance for Industry, In VivoPharmacokinetics and Bioavailability Studies and In Vitro DissolutionTesting for Levothyroxine Sodium Tablets, available atwww.fda.gov/cder/guidance/index.htm. A specifically preferreddissolution test is provided in Example 2, below.

[0058] A pharmaceutical composition of the invention is “stable” or“stabilized” if one or more of the active agents therein exhibit goodstability as determined by a standard potency test. More specifically,such compositions exhibit a potency loss of less than about 15%,preferably less than about 10%, more preferably less than about 1% toabout 5% as determined by the test. Potency can be evaluated by one or acombination of strategies known in the field. See the USP. A preferredpotency test compares loss or conversion of the active agent in thepresence (experimental) or absence (control) of a carrier or excipient.A specifically preferred potency test is provided in Examples 1 and 3,below.

[0059] In preferred embodiments, the pharmaceutical compositions of theinvention include, as active agent, levothyroxine (T4), preferably asalt thereof such as levothyroxine sodium USP. Such compositionstypically exhibit a levothyroxine (T4) plasma Cmax of between from about12 μg/dl to about 16 μg/dl, preferably as determined by the standardCmax test. Preferably, the In(Cmax) of the levothyroxine (T4) plasmalevel is between from about 1 to about 3.

[0060] The standard Cmax test can be performed by one or a combinationof strategies known in the field. See e.g., the USP. A preferred Cmaxtest is disclosed below in Examples 8 and 9.

[0061] Additionally preferred compositions in accord with the inventionprovide a triiodothyronine (T3) plasma Cmax of between from about 0.1ng/ml to about 10 ng/ml, preferably 0.5 ng/ml to about 2 ng/ml, asdetermined by the standard Cmax test. Typically, the In(Cmax) is betweenfrom about 0.01 to about 5. See Examples 8 and 9 for more information.

[0062] Further preferred compositions exhibit a levothyroxine (T4)plasma Tmax of between from about 0.5 hours to about 5 hours, preferablyas determined by a standard Tmax test. The standard Tmax test can beperformed by procedures generally known in the field. See e.g., the USP.A preferred Tmax test is disclosed below in Examples 8 and 9.

[0063] Still further preferred compositions of the invention exhibit atriiodothyronine (T3) plasma Tmax of between from about 10 hours toabout 20 hours, preferably about 12 to about 16 hours as determined bythe standard Tmax test.

[0064] Additionally preferred invention compositions feature alevothyroxine (T4) plasma AUC (0-t) of between from about 450 μg-hour/dlto about 600 μg-hour/dl, preferably 500 μg-hour/dl to about 550μg-hour/dl as determined by a standard AUC (0-t) test. Preferably, theIn[AUC(0-t)] is between from about 1 to about 10.

[0065] Standard methods for performing AUC (0-t) test determinations aregenerally known in the field. See e.g., the USP. Examples 8 and 9 belowprovide a specifically preferred method of determining the AUC (0-t).

[0066] Further preferred invention compositions feature atriiodothyronine (T3) AUC (0-t) of between from about 10 ng-hour/ml toabout 100 ng-hour/ml, preferably 20 ng-hour/ml to about 60 ng-hour/ml,as determined by the standard AUC (0-t) test. Preferably, theIn[AUC(0-t)] is between from about 1 to about 5.

[0067] As will be appreciated, many prior pharmaceutical formulationsinclude lactose or other sugars as a pharmaceutically acceptablecarrier. It has been found however, that sugars such as lactose canreact with active agents including the levothyroxine (T4) compositionsof the present invention. For example, and without wishing to be boundto theory, it is believed that lactose is particularly damaging to T4and T3 molecules via Schiff reactions. The invention address thisproblem by providing compositions that are essentially sugar-free.Particular invention compositions are essentially free of lactose.

[0068] Additionally, preferred pharmaceutical compositions of theinvention are provided in which the active material is a non-granulatedmaterial. Prior levothyroxine compositions have been granulated invarious size reduction machines to grains of less than, e.g., 5-20microns average particle size in order to be effectively incorporatedinto the administrable pharmaceutical composition. The granulationprocess subjects the active material to degrading heat, which can haveadverse effects on the active material, as well as reducing the activitylevel. Prior manufacturers purchase micronized levothyroxinemanufactured under DMF No. 4789, and then granulate it beforeincorporating it into the levothyroxine pharmaceutical product.

[0069] In the preferred method of the present invention, the rawmaterial is not granulated before incorporation into the pharmaceuticalcomposition. Rather, the ingredients of the preferred pharmaceutical aremixed and the mixture is subjected to direct compression to form thepharmaceutical tablets of appropriate dosage. As a result, the activityof the active ingredient is not degraded prior to the direct compressionstep. Bulk levothyroxine is obtained in a fine powdered form, preferablyfrom Biochemie GmbH, A-6250 Kundl, Austria. More importantly, the use ofthe preferred process results in a product which is immediatelydispersible in aqueous solution, to make the active ingredient availablefor absorption in the body. As used in this application,“non-granulated” means that the bulk USP compound is used withoutsubjecting it to granulators or similar high energy size reductionequipment before being mixed with the other pharmaceutical componentsand formed into the appropriate pill. Preferably, the bulk activeingredient is mixed with the appropriate amounts of other ingredientsand directly compressed into pill form. Since it is not necessary togranulate the material, it is not necessary to subject it to degradingtemperatures in the process of forming the pharmaceutical compositionscontaining the active materials. In the present process we start withmicronized active material, which merely needs to be blended with the Band other materials and then compressed. Others have to be granulated,and then dried, which steps interfere with the dissolution of the activematerial. The drying temperatures employed in manufacturing other activeingredients can cause degradation of the levothyroxine, as experiencedin other available thyroxine. It has been found that providing theinvention compositions in a non-granulated format helps to reduce oreliminate active agent degradation, presumably by facilitating areduction in friction, and thus degrading heat, during compression ofthe compositions into pills.

[0070] Practice of the invention is compatible with several β-formmicrocrystalline cellulose grades. Preferably, the β-formmicrocrystalline cellulose has a bulk density of between from about 0.10g/cm³ to about 0.35 g/cm³, more preferably between from about 0.15 g/cm³to about 0.25 g/cm³, still more preferably between from about 0.17 g/cm³to about 0.23 g/cm³, most preferably between from about 0.19 g/cm³ toabout 0.21 g/cm³.

[0071] Further preferred grades of the β-form microcrystalline celluloseare substantially non-conductive. Preferably, the β-formmicrocrystalline cellulose has a conductivity of less than about 200μS/cm, more preferably, less than about 75 μS/cm, still more preferablybetween from about 0.5 μS/cm to 50 μS/cm, most preferably between fromabout 15 μS/cm to 30 μS/cm.

[0072] A specifically preferred β-form microcrystalline cellulose issold by Asahi Chemical Industry Co., Ltd (Tokyo, Japan) as Ceolus (TypeKG-801 and/or KG-802).

[0073] Additionally preferred compositions of the invention have apost-packaging potency of between from about 95% to about 120%,preferably 98% to about 110% as determined by the standard potency test.

[0074] The present invention is a pharmaceutical product that is in theform of a solid dosage, such as a sublingual lozenge, buccal tablet,oral lozenge, suppository or a compressed tablet. The pharmaceuticallyactive ingredient is dry mixed with the β-form of the microcrystallinecellulose, optionally with additional excipients, and formed into asuitable solid dosage.

[0075] Preferred tablets according to the invention have a totalhardness of between from about 1 to about 30 KP, preferably about 6 toabout 14 KP as determined by a standard hardness test. Methods fordetermining tablet hardness are generally known in the field. See e.g.,the USP. A preferred standard hardness test is disclosed below inExample 4.

[0076] Additionally preferred pharmaceutical compositions includingthose in tablet format preferably include less than about 10% totalimpurities, more preferably less than about 5% of same as determined bya standard impurity test.

[0077] Reference herein to the “standard impurity test” means a USPrecognized assay for detecting and preferably quantitating active drugdegradation products. In embodiments in which levothyroxine orliothyronine break-downs are to be monitored, such products include, butare not limited to, at least one of diiodothyronine (T2),triiodothyronine (T3), levothyroxine, triiodothyroacetic acid amide,triiodothyroethylamine, triiodothyroacetic acid, triiodothyroethylalcohol, tetraiodothyroacetic acid amide, tetraiodothyroacetic acid,triiodothyroethane, and tetraiodothyroethane. Of particular interest arediiodothyronine (T2), triiodothyronine (T3), triiodothyroacetic acid,and tetraiodothyroacetic acid impurities.

[0078] A preferred impurity test for monitoring levothyroxine andliothyronine breakdown products involves liquid chromatography (LC)separation and detection, more preferably HPLC. Specifically preferredimpurity tests are provided below in Examples 5 and 6

[0079] Further preferred compositions in accord with the inventioninclude one or more standard disintegrating agents, preferablycrosscarmellose, more preferably a salt of same. Still further preferredcompositions include a pharmaceutically acceptable additive or excipientsuch as a magnesium salt.

[0080] The present invention can be prepared as a direct compressionformula, dry granulation formula, or as a wet granulation formula, withor without preblending of the drug, although preferably withpreblending.

[0081] The pharmaceutically active ingredient can be any type ofmedication which acts locally in the mouth or systemically, which is thecase of the latter, can be administered orally to transmit the activemedicament into the gastrointestinal tract and into the blood, fluidsand tissues of the body. Alternatively, the medicament can be of anytype of medication which acts through the buccal tissues of the mouth totransmit the active ingredient directly into the blood stream thusavoiding first liver metabolism and by the gastric and intestinal fluidswhich often have an adverse inactivating or destructive action on manyactive ingredients unless they are specially protected against suchfluids as by means of an enteric coating or the like. The activeingredient can also be of a type of medication which can be transmittedinto the blood circulation through the rectal tissues.

[0082] Representative active medicaments include antacids,antimicrobials, coronary dilators, peripheral vasodilators, antipsychotropics, antimanics, stimulants, antihistamines, laxatives,decongestants, vitamins, gastrosedatives, antidiarrheal preparations,vasodilators, antiarrythmics, vasoconstrictors and migraine treatments,anticoagulants and antithrombotic drugs, analgesics, antihypnotics,sedatives. anticonvulsants, neuromuscular drugs, hyper and hypoglycemicagents, thyroid and antithyroid preparations, diuretics, antispasmodics,uterine relaxants, mineral and nutritional additives, antiobesity drugs,anabolic drugs, erythropoietic drugs, antiasthematics, expectorants,cough suppressants, mucolytics, antiuricemic drugs, and drugs orsubstances acting locally in the mouth.

[0083] Typical active medicaments include gastrointestinal sedativessuch as metoclopramide and propantheline bromide, antacids such asaluminum trisilicate, aluminum hydroxide and cimetidine, asprin-likedrugs such as phenylbutazone, indomethacin, and naproxen. ibuprofen,flurbiprofen, diclofenac, dexamethasone, prednisone and prednisolone,coronary vasodialator drugs such as glyceryl trinitrate, isosorbidedinitrate and pentaerythritol tetranitrate, peripheral and cerebralvasodilators such as soloctidilum, vincamine, naftidrofuryl oxalate,comesylate, cyclandelate, papaverine and nicotinic acid, antimicrobials,such as erythromycin stearate, cephalexin, nalidixic acid, tetracyclinehydrochloride, ampicillin, flucolaxacillin sodium, hexamine mandelateand hexamine hippurate, neuroleptic drugs such as fluazepam, diazepam,temazepam, amitryptyline, doxepin, lithium carbonate, lithium sulfate,chlorpromazine, thioridazine, trifluperazine, fluphenazine,piperothiazine, haloperidol, maprotiline hydrochloride, imipramine anddesmethylimipramine, central nervous stimulants such as methylphenidate,ephedrine, epinephrine, isoproterenol, amphetamine sulfate andamphetamine hydrochloride, anitidrugs such as diphenylhydramine,diphenylpyramine, chlorpheniramine and brompheniramine, antidiarrhealdrugs such as bisacodyl and magnesium hydroxide, the laxative drug,dioctyl sodium sulfosuccinate, nutritional supplements such as ascorbicacid, alpha tocopherol, thiamine and pyridoxine, antispasmotics such asdicyclomine and diphenoxylate, drugs effecting the rhythm of the heartsuch as verapamil, nifedepine. diltiazem, procainamide, disopyramide,bretylium tosylate, quinidine sulfate and quinidine gluconate, drugsused in the treatment of hypertension such as propranolol hydrochloride,guanethidine monosulphate, methyldopa, oxprenolol hydrochloride,captopril, Actace and hydralazine, drugs used in the treatment ofmigraine such as ergotamine, drugs effecting coagulability of blood suchas epsilon aminocaproic acid and protamine sulfate, analgesic drugs suchas acetylsalicyclic acid, acetaminophen, codeine phosphate, codeinesulfate, oxycodone, dihydrocodeine tartrate, oxydodeinone, morphine,heroin, nalbuphine, butorphanol tartrate, pentazocine hydrochloride,cyclazacine, pethidine, buprenorphine, scopolamine and mefenamic acid,antidrugs such as phenytoin sodium and sodium valproate, neuromusculardrugs such as dantrolene sodium, substances used in the treatment ofdiabetes, such as tolbutamide, diabenase glucagon and insulin, drugsused in the treatment of thyroid gland dysfunction such astriiodothyronine, liothyronine sodium, levothyroxilne sodium and relatedcompounds, and propylthiouracil, diuretic drugs, such as furosemide,chlorthalidone, hydrochlorthiazide, spironolactone and triampterene, theuterine relaxant drugritodrine, appetite suppressants such asfenfluramine hydrochloride, phentermine and diethylproprionhydrochloride,antidrugs stimulants such as aminophylline, theophylline,salbutamol, orciprenaline sulphate and terbutaline sulphate, expectorantdrug such as guaiphenesin, cough suppressants such as dextromethorphanand mescaline, mucolytic drugs such as carbocisteine, antiseptics suchas cetylpyridinium chloride, tyrothricin and chlorhexidine, decongestantdrugs such as phenylpropanolamine and pseudoephedrine, hypnotic drugssuch as dichloralphenazone and nitrazepam,antidrugs H₁ blockers such aspromethazine theociate, haemopoetic drugs such as ferrous sulphate,folic acid and calcium gluconate, uricosuric drugs such assulphinpyrazine, allopurinol and probenecid and the like. It isunderstood that the invention is not restricted to the abovemedications.

[0084] The amount of pharmaceutically active ingredient in the presentcomposition can vary widely, as desired. Preferably, the activeingredient is present in a composition of the present invention in aneffective dosage amount. Exemplary of a range that the active ingredientmay be present in a composition in accordance with the present inventionis from about 0.000001 to about 10 weight %. More preferably, the amountof active ingredient is present in the range of about 0.001 to 5 weight%.

[0085] Of course, it should be understood that any suitablepharmaceutically acceptable form of the active ingredient can beemployed in the compositions of the present invention, i.e., the freebase or a pharmaceutically acceptable salt thereof, e.g., levothyroxinesodium salt, etc.

[0086] When the pharmaceutically active moiety is levothyroxine sodium,the preferred amount of the active moiety in the composition is presentin the range of about 0.00005 to about 5 weight %. The more preferredrange is from about 0.001 to about 1.0 weight %, and the most preferredrange is from about 0.002 to about 0.6 weight % levothyroxine. Theminimum amount of levothyroxine can vary, so long as an effective amountis utilized to cause the desired pharmacological effect. Typically, thedosage forms have a content of levothyroxine in the range of about 25 to300 micrograms per 145 milligram pill for human applications, and about100 to 800 micrograms per 145 mg pill for veterinary applications.

[0087] In accordance with the present invention, a goal of levothyroxinereplacement therapy is to achieve and maintain a clinical andbiochemical euthyroid state, whereas a goal of suppressive therapy is toinhibit growth and/or function of abnormal thyroid tissue. A dose oflevothyroxine that is adequate to achieve these goals depends of courseon a variety of factors including the patient's age, body weight,cardiovascular status, concomitant medical conditions, includingpregnancy, concomitant medications, and the specific nature of thecondition being treated. Hence, the following recommendations serve onlyas dosing guidelines. It should be understood by those versed in thisart that dosing should be individualized and adjustments made based onperiodic assessment of a patient's clinical response and laboratoryparameters.

[0088] Preferably, but not necessarily, when using levothyroxine totreat, it should be taken in the morning on an empty stomach, at leastone-half hour before any food is eaten. In addition, levothyroxine ispreferably taken at least about 4 hours apart from drugs that are knownto interfere with its absorption.

[0089] Due to the long half-life of levothyroxine, the peak therapeuticeffect at a given dose of levothyroxine sodium may not be attained forabout 4 to about 6 weeks.

[0090] In people older than 50 years, who have been recently treated forhyperthyroidism or who have been hypothyroid for only a short time (suchas a few months), the average full replacement dose of levothyroxinesodium is approximately 1.7 mcg/kg/day (e.g., about 100 to about 125mcg/day for a 70 kg adult). Older patients may require less than 1mcg/kg/day. Levothyroxine sodium doses greater than about 200 mcg/daymay or may not be required.

[0091] For most patients older than 50 years or for patients under 50years of age with underlying cardiac disease, an initial starting doseof about 25 to about 50 mcg/day of levothyroxine sodium is recommended,with gradual increments in dose at about 6 to about 8 week intervals, asneeded. The recommended starting dose of levothyroxine sodium in elderlypatients with cardiac disease is about 12.5 to about 25 mcg/day, withgradual dose increments at about 4 to about 6 week intervals. Thelevothyroxine sodium dose is generally adjusted in about 12.5 to about25 mcg increments until the patient with primary hypothyroidism isclinically euthyroid and the serum TSH has normalized.

[0092] In patients with severe hypothyroidism, the recommended initiallevothyroxine sodium dose is about 12.5 to about 25 mcg/day withincreases of about 25 mcg/day about every 2 to about 4 weeks,accompanied by clinical and laboratory assessment, until the TSH levelis normalized.

[0093] In patients with secondary (pituitary)or tertiary (hypothalamic)hypothyroidism, the levothyroxine sodium dose should be titrated untilthe patient is clinically euthyroid and the serum free-T₄ level isrestored to the upper half of the normal range.

[0094] In children, levothyroxine therapy may be instituted at fullreplacement doses as soon as possible. Levothyroxine compositions of thepresent invention may be administered to infants and children who cannotswallow intact tablets by crushing the tablet and suspending the freshlycrushed tablet in a small amount (5-10 mL or 1-2 teaspoons) of water.This suspension can be administered by spoon or dropper. Foods thatdecrease absorption of levothyroxine, such as soybean infant formula,should not be used for administering levothyroxine sodium tablets.

[0095] A recommended starting dose of levothyroxine sodium in newborninfants is about 10 to about 15 mcg/kg/day. A lower starting dose (e.g.,about 25 mcg/day) may be considered in infants at risk for cardiacfailure, and the dose should be increased in 4-6 weeks as needed basedon clinical and laboratory response to treatment. In infants with verylow (<about 5 mcg/dL) or undetectable serum T₄ concentrations, arecommended initial starting dose is about 50 mcg/day of levothyroxinesodium.

[0096] As indicated above, levothyroxine therapy is usually initiated atfull replacement doses, with the recommended dose per body weightdecreasing with age (see Dose Table below). However, in children withchronic or severe hypothyroidism, an initial dose of about 25 mcg/day oflevothyroxine sodium is recommended with increments of 25 mcg every 2-4weeks until the desired effect is achieved. Hyperactivity in an olderchild may be minimized if the starting dose is one-fourth of therecommended full replacement dose, and the dose is then increased on aweekly basis by an amount equal to one-fourth the full-recommendedreplacement dose until the full recommended replacement dose is reached.Dose Table: Levothyroxine Sodium Dosing Guidelines for PediatricHypothyroidism AGE Daily Dose per Kg Body Weight^(a)  0-3 months 10-15mcg/kg/day  3-6 months  8-10 mcg/kg/day 6-12 months  6-8 mcg/kg/day  1-5years  5-6 mcg/kg/day 6-12 years  4-5 mcg/kg/day  >12 years  2-3mcg/kg/day Growth and puberty complete   1.7 mcg/kg/day

[0097] Levothyroxine sodium tablets, USP, in accordance with the presentinvention may be supplied as oval or violin-shaped, color-coded, potencymarked tablets in, for example, 12 strengths as indicated in theStrength Table Strength Table Levothyroxine Strength Tablets (mcg) Color25 Orange 50 White 75 Purple 88 Olive 100 Yellow 112 Rose 125 Brown 137Dark Blue 150 Blue 175 Turquiose 200 Pink 300 Green

[0098] When the pharmaceutically active moiety is liothyronine sodium,the preferred amount of the active moiety in the composition is presentin the range of about 0.000005 to 0.5 weight %. The more preferred rangeis from about 0.00001 to 0.1 weight %, and the most preferred range isfrom about 0.00004 to about 0.002 weight % liothyronine. The minimumamount of lyothyronine can vary, so long as an effective amount isutilized to cause the desired pharmacological effect. Typically, thedosage forms have a content of levothyroxine in the range of about 5 to50 micograms per 145 milligram pill for human applications.

[0099] The β-form microcrystalline cellulose product of the presentinvention is prepared by forming a wet cake, drying the cake with a drumdryer, then passing the dried product through a screen or mill forsizing which produces a β-sheet microcrystalline cellulose which has aflat needle shape, as disclosed in U.S. Pat. No. 5,574,150. Such β-sheetmicrocrystalline product is available from Asahi Chemical of Japanand/or marketed by FMC Company of Newark, Del., under the trademarkCeolus®. The morphology and performance characteristics of the Ceolus®product are different from those of α-form microcellulose products (forexample, Avicel® and Emcocel®), and are suitable for preparing thepresent stabilized pharmaceutical composition.

[0100] The amount of β-form microcrystalline product used in the presentcomposition is at least 50 weight % of the final composition.Preferably, the amount of β-form microcrystalline product is in therange of about 50 to 99 weight %. Most preferably, the amount of β-formmicrocrystalline product is in the range of about 60 to 90 weight % ofthe final composition.

[0101] Other suitable excipients for the present invention includefillers such as starch, alkaline inorganic salts such as trisodiumphosphate, tricalcium phosphate, calcium sulfate and sodium or magnesiumcarbonate. The fillers can be present in the present composition in therange of about 0 to 50 weight %.

[0102] Suitable disintegrating agents include corn starch, cross-linkedsodium carboxymethylcellulose (crosscarmellose) and cross-linkedpolyvinyipyrrolidone (crospovidone). A preferred disintegrating agent iscrosscarmellose. The amount of disintegrating agent used is in the rangeof about 0 to 50 weight %. Preferably, the disintegrating agent is inthe range of about 5 to 40 weight %, more preferably about 10 to about30 weight %. This is in substantial excess of the recommended levels ofsuch materials. For example, the recommended loading of crosscarmelloseis 0.5 to about 2% by weight. However, it has been found that the higherloadings of the disintegrating agents substantially improves the abilityof the product to disperse in aqueous media.

[0103] Suitable gildents for use in the present invention includecolloidal silicon dioxide and talc. The amount of gildent in the presentcomposition is from about 0 to 5 weight %, and the preferred amount isabout 0 to 2 weight %.

[0104] Suitable lubricants include magnesium and zinc stearate, sodiumstearate fumarate and sodium and magnesium lauryl sulfate. A preferredlubricant is magnesium stearate. The amount of lubricant is typically inthe range of about 0 to 5 weight %, preferably in the range of about 0.1to 3 weight %.

[0105] The oral pharmaceutical product is prepared by thoroughlyintermixing the active moiety and the β-form of microcrystallinecellulose, along with other excipients to form the oral dosage. Foodgrade dyes can also be added. For example, it is common to distinguishdosages of various potency by the color characteristics of such dyes.

[0106] As discussed, a preferred immediate release pharmaceuticalcomposition in tablet form includes levothyroxine sodium. In a preferredembodiment, the composition includes at least one of, preferably all ofthe following:

[0107] a) between from about 0.01 mg/tablet to about 500 mg/tabletlevothyroxine sodium (USP),

[0108] b) between from about 100 mg/tablet to about 110 mg/tablet ofmicrocrystalline β-cellulose, NF (Ceolus) having a bulk density ofbetween from about 0.10 g/cm³ to about 0.35 g/cm³,

[0109] c) between from about 25 mg/tablet to about 50 mg/tablet ofcrosscarmellose sodium, NF (Ac-di-sol); and

[0110] d) between from about 0.5 mg/tablet to about 5 mg/tablet ofmagnesium stearate, NF.

[0111] Preferably, the composition further comprises at least onepharmaceutically acceptable coloring agent.

[0112] More particular methods according to the invention providecompositions having less than about 5% total impurities as determined bythe standard impurity test. Preferably, the method further comprisesforming a tablet, particularly those tablets having a raised violinconfiguration.

[0113] The stabilized oral dosages of thyroid hormone are prepared byforming a trituration of the active moiety (i.e. levothyroxine sodiumand/or liothyronine sodium) and β-form microcrystalline cellulose. Thetrituration is blended with β-form microcrystalline cellulose andadditional excipients and compressed into oral dosages.

[0114] Design of the tableting apparatus is important, in order tomaintain consistency from one oral dosage to the next. The formulationbatches are a blend of solid compositions of various shapes and sizes.Blending is used to achieve a measure of homogeneity. In particular theactive thyroid moiety is desired to be evenly distributed throughout thebatch. In a typical 410 kg batch, the amount of active moiety representsless than 1 kg of the total weight. For example, when producing 145 mgtablets with a 300 mcg dosage, approximately 0.8 kg of a 410 kg batch isthe active moiety. In addition each tablet is formulated to contain 100%label claim potency.

[0115] It is typical for compressible medicament tablets to be formedusing a 2:1 fill to compression ratio. However, for medicament tabletsformed using the present invention a fill to compression ratio from3.3:1 to 4:1 is needed to obtain desired tablet density. The β-formmicrocrystalline cellulose has a lower bulk density, as compared toother excipients.

[0116] Higher tablet density can be accomplished by adjusting atableting machine to increase the compression ratio. Tableting machinesare commonly known to practitioners in the art and include thoseavailable from Manesty and Stokes. It has been found that making suchadjustments to the compression ratio results in poor tablet surfacefinish as well as inconsistent tablet weights. Instead, the design ofthe tableting dies should be adjusted. It has been determined thatduring the filling of the tableting dies, a minimum of 5-6 mm dieoverfill. In most cases this requires replacement of the usual tabletingdies with dies which are an additional 2-3 mm deep.

[0117] When using the extra-deep dies and a compression ratio of from3.3:1 to 4.0:1, consistent weight tablets with good surface finish wereproduced.

[0118] Preferably, the shape of the tablet is configured to increaseheat transfer away from the tablet. More preferred tablets have asurface area per tablet of between from about 0.9 in.² to about 0.15in.², preferably about 0.115in.², to assist such heat transfer.Additional tablet configurations are contemplated e.g., tablets that arebeveled and/or include a notch. A preferred tablet shape is a raisedviolin configuration, as shown in FIG. 1C.

[0119] The following examples are given by way of illustration only andare not to be considered limitations of this invention or many apparentvariations of which are possible without departing from the spirit orscope thereof.

EXAMPLE 1 Stability Tests

[0120] Stability testing was performed on samples of the thyroid hormonedrug formulation used in manufacturing tablets with an active moiety oflevothyroxine sodium. Tests were performed on direct compressionformulations for dosage strength of 25 mcg. Example 1 tablets comprisethe β-form microcrystalline cellulose while Control 1 tablets comprisethe traditional -for m microcrystalline cellulose. The composition ofExample 1 and Control 1 tablets are presented in Table 1 and stabilitytest results in Table 2: TABLE 1 Tablet Formulation for 25 mcg Dosagesof Levothyroxine Sodium Example 1 Control 1 Tablet Tablet Component0.0297 mg 0.0297 mg Levothyroxine Sodium, USP 108.55 mg β - sheetmicrocrystalline cellulose 108.55 mg β - form microcrystalline cellulose35.079 mg 35.079 mg Croscarmellose Sodium, NF 0.352 mg 0.352 mg FD&CYellow #6 16% (14-20% 1.018 mg 1.018 mg Magnesium Stearate, NF 145.0 mg145.0 mg Total

[0121] TABLE 2 Stability Test - Potency at 25° C. - % Label ClaimElapsed Time 0 73 Days 13 months 15 months Example 1Tablet 106.4 105.5104.4 102.9 Example 1% Potency 0.0 0.9% 2.0% 3.5% Loss % Change perMonth 0.0 0.37 0.15 0.23 Control 1 Tablet 99.2 89.5 85.0 83.2 Control 1%Potency Loss 0.0 2.7% 14.2% 16.0% % Change per Month 0.0 1.11 1.09 1.07

[0122] As seen in Table 2, the stability of pharmaceutical formulationsof the present invention is improved significantly by the use of theβ-sheet microcrystalline cellulose. Potency loss of the presentinvention after 15 months is 3.5%, versus 16.0% potency loss experiencedin a similar formulation with the α-form microcrystalline cellulose. Theaverage loss in potency per month in the case of the compositions of thepresent invention was only about 0.2% per month, as compared to over 1%per month for the T4 products which included β-form microcrystallinecellulose, thus demonstrating a stability which is about 3 to 4 timesbetter than the T4 products which utilized α-form microcrystallinecellulose.

[0123] Tableting testing was performed on the formulation for Example 1tablets. Initial results with standard die depths provided a relativestandard deviation of 2.2 to 3.5% tablet weight. With the use of theherein described extra deep tablet dies, the relative standard deviationis 1.2%. Testing was performed on a Manesty tableting machine withcompression ratios of from 3.3:1 to 4.0:1.

[0124] Tablet quality is also dependent upon the storage of the β-sheetmicrocrystalline cellulose. Best results are achieved when the celluloseis received in drums or portable containers instead of bags. The bagform suffers from compression during transportation from raw materialsuppliers. Test results for tableting are presented in attached ExhibitA.

[0125] Additional examples of solid dosage formulations are illustratedin Tables 3 and 4. Stability testing data of additional examples areillustrated in Table 5. TABLE 3 Tablet Formulation for Dosages ofLevothyroxine Sodium (per tablet) 25 mcg 50 mcg 75 mcg Dosage DosageDosage Component 0.025 mg 0.0500 mg 0.0750 mg levothyroxine sodium108.529 mg 108.856 mg 108.438 mg β-form micro- crystalline cellulose35.079 mg 35.079 mg 35.079 mg croscarmellose sodium 0.352 mg 0.383 mgfood grade dye 1.018 mg 1.018 mg 1.018 mg magnesium stearate 145 mg/ 145mg/ 145 mg/ Total tablet tablet tablet

[0126] TABLE 4 Tablet Formulation for Dosages of Levothyroxine Sodium(per tablet) 100 mcg 112 mcg 300 mcg Component Dosage Dosage Dosage0.100 mg 0.112 mg 0.300 mg Levothyroxine sodium 108.406 mg 107.711 mg108.451 mg β-form micro- crystalline cellulose 35.079 mg 35.079 mg35.079 mg croscarmellose 0.388 mg 1.080 mg 0.142 mg food grade dye 1.018mg 1.018 mg 1.1018 mg magnesium stearate 145 mg/ 145 mg/ 145 mg/ Totaltablet tablet tablet

[0127] Table 5 shows drug stability data for a number of the aboveformulations: TABLE 5 Stability Test - Potency at 25° C. - % Label ClaimLevothyroxine Na Test Interval (months) Test Initi 6 12 18  25 μg Dose26.2 25.6 25.5 25.3 % Label Claim 104. 102. 102. 101. % of InitialResult 100. 97.5 97.3 96.6 % Change 0.0 2.6 2.8 3.6 % Change per month0.0 0.43 0.23 0.2  50 μG Dose 51.0 49.9 48.9 48.4 % Label Claim 102.99.7 97.7 96.7 % of Initial Result 100. 97.7 95.8 94.8 % Change 0.0 2.34.3 5.3 % Change per month 0.0 0.38 0.36 0.29 112 μg Dose 113. 113. 109.105. % Label Claim 101. 101. 97.8 94.5 % of Initial Result 100. 100.96.6 93.4 % Change 0.0 0.3 3.4 6.7 % Change per month 0.0 0.05 0.28 0.37200 μg Dose 202. 196. 198. 196. % Label Claim 101. 98.4 99.3 98.3 % ofInitial Result 100. 97.3 98.2 97.2 % Change 0.0 2.7 1.7 2.8 % Change permonth 0.0 0.45 0.14 0.15

[0128] Thus the formulations of the present invention provide extremestability for the levothyroxine activity over an extended shelf life forthese pharmaceutical products.

EXAMPLE 2 Dissolution Tests

[0129] The following preferred method for testing potency will sometimesbe referred to herein as method number: AM-004B TABLE 6 Dissolution TestProcedure Chromatographic Conditions Mobile Phase: Degassed and filteredmixture of methanol and 0.1% phosphoric acid (60:40). Column: C₁₈3.9 mm× 30 cm Flow Rate: 2.0 ml/minute Detector: Deuterium set at 225 nmInjection Volume: 800 μL System Suitability: Chromatograph 6 replicateinjections of the standard preparation. 1.0 RDS for the standardreplicates must not be more than 4.0%. 2.0 The tailing factor must notbe more than 1.5. Medium: 0.01 N hydrochloric acid containing 0.2%sodium lauryl sulfate; 500 ± 5 ml; 37 ± 0.5° C. This solution is veryfoamy; excessive mixing, shaking, and pouring will make reading themeniscus on the graduated cylinder difficult. Apparatus: Apparatus 2(Paddles) Apparatus Cleaning: The apparatus is to be cleaned immediatelyafter use or if left idle for more than 12 hours. Clean paddles byrinsing with distilled water, methanol, and distilled water again. Blotto dry with Kimwipes. Clean vessels by rinsing with hot tap water,microdetergent, hot tap water, and distilled water. Dry using papertowels. Paddle Speed: 50 rpm Incubation Period: Up to 45 minutesStandard Solutions: Transfer about 50 mg USP Levothyroxine RS,accurately weighed, into a 100 ml volumetric flask. Add approximately 30ml of methanol, dissolve and dilute to volume with methanol, mix. Usingthis solution, standard solutions are prepared in a volumetric flaskusing Dissolution Media, diluting to a concentration that comes near tothe theoretical concentration of the tablet in 500 ml of DissolutionMedia. Use a pipette to gently add the Dissolution media to preventfoaming. *Calculate and use the actual concentration in % Dissolutedequation Sample Preparation: One tablet is placed into each vessel ofthe dissolution apparatus. Sample each vessel after the incubation time,as stated above. Pass a portion of the sample through a 0.45 micronfilter sufficient to equilibrate the filer. Filters are to bepre-qualified according to SOP (C1-730). Use a new filter for eachvessel. Procedure: Inject 800 μl of standard and sample into the columnand record the chromatograms. Measure the responses of the major peaks.Calculate the amount of Levothyroxine dissolved in each vessel by theformula below.

[0130] ${\begin{matrix}{{Calculations}:} \\{\% \quad {Dissoluted}}\end{matrix}\frac{{Sample}\quad {Area}}{{Std}.\quad {Area}} \times \frac{798.86}{776.87} \times \frac{{Amt}.\quad {Std}.\quad {Injected}}{{Amt}.\quad {Samp}.\quad {Injected}} \times 100\%} = {\% \quad {Dissoluted}}$

[0131] Where

[0132] 798.86=molecular weight of Levothyroxine as Sodium Salt

[0133] 776.87=molecular weight of Levothyroxine (as Base) TABLE 7Acceptance Criteria STAGE #TESTED ACCEPTANCE CRITERIA Q = 70% S-1 6 Eachunit is not less than Q + 5% S-2 6 Average of 12 units (S-1 + S-2) isequal to or greater than Q, and no unit is less than Q − 15% S-3 12Average of 24 units (S-1 + S-2 + S-3) is equal to or greater than Q andnot more than 2 units are less than Q − 15%, and no unit is less than Q− 25%

[0134] Table 8 shows comparative dissolution data for all strengths ofLevoxyl® tablets. TABLE 8 Comparative Dissolution Data 0 1 2.5 5 7.5 10minutes minute minute minutes minutes minutes  25 mcg 0.0% 84.9% 93.7%90.9% 88.6% 84.7%  50 mcg 0.0% 82.8% 92.7% 91.8% 87.8% 84.4%  75 mcg0.0% 78.9% 93.6% 92.2% 88.3% 84.7%  88 mcg 0.0% 79.8% 95.6% 94.1% 90.5%86.9% 100 mcg 0.0% 85.4% 94.8% 94.5% 90.7% 86.5% 112 mcg 0.0% 75.5%91.1% 90.7% 87.0% 82.9% 125 mcg 0.0% 75.0% 96.5% 95.5% 91.7% 87.8% 137mcg 0.0% 79.9% 93.9% 93.2% 89.4% 85.7% 150 mcg 0.0% 75.6% 91.9% 91.4%88.7% 84.6% 175 mcg 0.0% 84.2% 95.7% 93.5% 90.3% 85.5% 200 mcg 0.0%76.5% 94.9% 94.6% 91.0% 87.6% 300 mcg 0.0% 74.5% 92.1% 91.4% 87.9% 84.0%

[0135]FIG. 4 depicts graphs showing the mean results for each of thetablet strengths of Levoxyl® tested. Each point is the mean of threedissolutions, testing 12 tablets per dissolution or n=36. The data ispresented as percent of label claim dissoluted vs. dissolution time.

[0136] The results demonstrate that the multi-point dissolution profilesfor Levoxyl® tablets are similar across a wide variety of tabletstrengths. Moreover, all strengths substantially exceed the requirementsfor immediate release oral dosage forms (i.e. at least 80% dissolutedwith 15 -20 minutes). In each dosage form, these pills were over 90%dissoluted within two and a half minutes.

[0137] The extremely rapid dispersion rates for the tablets of thepresent invention make possible a simplified treatment method forinfants or others who have difficulty swallowing pills. In thisapproach, the appropriate dosage for the patient in question, in animmediate release pill made in accordance with the present invention, issimply mixed with a suitable amount, e.g. 50-200 ml, of aqueous fluid,such as water, soft drinks, juice, milk, etc. The immediate release pillis easily dissoluted in the fluid, optionally with stirring or shaking,and simply administered to the patient.

EXAMPLE 3 Potency Test

[0138] The following method for testing potency of the tablets willsometimes be referred to herein as method number: AM-003. Alternatively,the tablet potency can be tested according to method AM-021. Methodnumber: AM-021 is the same as method number: AM-003, except the tabletsare dissolved whole without first grinding the tablets into a powder, aswith method number: AM-003.

[0139] Method Reference

[0140] USP 24 pp. 968-970

[0141] Chromatographic Conditions

[0142] Mobile Phase: 65:35:0.05 H20: CAN: H3P04 degassed and filtered;mobile phase composition may be altered to achieve a satisfactoryresolution factor.

[0143] Column

[0144] ACN, 4.6 mm×25 to 30 cm

[0145] Flow Rate

[0146] 1.5 ml/minute

[0147] Detector

[0148] Deuterium, set at 225 nm

[0149] Injection Volume

[0150] 100 ml

[0151] System Suitability

[0152] Chromatograph 5 replicate injections of the standard preparation.Record the peak responses as directed under “Procedure”. 1.0 RSD for thestandard replicates must not be more than 2.0% for T₄ 2.0 Calculate theresolution factor R on one of the five replicates. The R-value must begreater than or equal to 5.0 to proceed. See Method QC-009.

[0153] Standard Preparation

[0154] Accurately weight 25 mg of USP Levothyroxine RS and transfer toan amber 250-ml volumetric flask. Add approximately 50 ml extractionmobile phase. Let stand for 20 minutes with occasional swirling.Sonicate for 30 seconds. Gradually add more extraction solution andrepeat sonication until no undissolved particles are observed. Dilute tovolume with extraction solution. Mix well. The concentration of T₄ isabout 100 μg/ml. Also dissolve an accurately weighed quantity of USPLiothyronine RS to yield about 100 mg/ml, done as above with USPLevothyroxine R S. Label this solution as stock T₃-A. Stock Standarddilution: 1. Pipette 10.0 ml stock T₃-A into a 500 ml Type A volumetricflask. 2. Dilute to volume with Mobile Phase for a concentration ofabout 2 μg/ml. Mix well and label this solution as std. T₃-B. 3. Pipette50.0 ml each from the T₄ and T₃-B stock standards and transfer into a500-ml Type A volumetric flask Dilute to volume with mobile phase andmix well. Label this standard as T₃/T₄ working standard. Theconcentration of the working standard should be about 0.2 μg/ml T₃ and10.0 μg/ml T_(4.)

[0155] Assay Preparation

[0156] Weigh not less than the specified tablet quantity and calculatethe average tablet weight. Crush tablets into a uniform fine powder witha mortar and pestle. Tare a polypropylene weigh boat.

[0157] Accurately weigh (to 0.1 mg) a portion of the powder into thetared weigh boat using a preconditioned stainless steel scoop or spatula(either Teflon coated or uncoated). The spatula or scoop ispreconditioned by dipping it into the powder. Use the Sample Calculationbelow to achieve 50 ml of a 10 μg/ml assay solution.

[0158] Record the sample weight taken. Carefully transfer the sampleinto an Erlenmeyer flask, reweigh the weigh boat and subtract theresidual weight from the weight taken to obtain the actual sampleweight. Pipette 50 ml of mobile phase into the flask. Cover the flaskwith parafilm, sonicate for approximately 10 seconds and vortex forapproximately 235 seconds at a speed of 6 or greater. Observe samplepreparation, and if clumping is noted, repeat the sonication and/orvortex steps. Centrifuge (˜3,000 rpm) for NLT 1 minute until a clearsupernatant is achieved. Transfer a portion of the supernatant to anauto sampler vial.

[0159] For In-Process granulation analysis, use the theoretical tabletweight (0.1455 g) in place of (weight of tablets/number of tablets) inthe formula below.

[0160] Sample Calculation${\frac{{Weight}\quad {of}\quad {Tablets}}{{Number}\quad {of}\quad {Tablets}} \times \frac{10\quad \mu \quad g}{ml} \times \frac{50\quad {ml}}{{Dose}\quad \left( {\mu g} \right)}} = {{Amount}\quad {to}\quad {Weight}\quad {Out}\quad {per}\quad {Assay}}$

[0161] Procedure

[0162] Separately inject 100 μl of the sample onto the column. Recordthe responses of the analyte peak and calculate % label claim asfollows.

[0163] Calculations

Sample Area×Std conc. (μg)×50 ml×avg. tablet weight ing×798.86=μg/dose×100=% Label Claim

Standard Area (ml) Actual Sample wt in g 776.87 Label Claim

[0164] Where

[0165] 798.86=molecular weight of Levothyroxine as the Sodium Salt

[0166] 776.87=molecular weight of Levothyroxine Standard Base

[0167] Results

[0168]FIGS. 5A and 5B show HPLC chromatograms of levothyroxine andliothyronine controls (T3/T4 working standard, shown in FIG. 5A) and anexperimental sample made in accordance with the present invention asdescribed above.(FIG. 5B). The peaks in both chromatograms in the areaof 1.325 to 3.1 correspond to materials in the solvent. The peak atabout 7.2 in FIG. 5A shows the presence of T3. FIG. 5B shows the absenceof T3, as well as the absence of other related products or degradationproducts of levothyroxine.

EXAMPLE 4 Hardness Test

[0169] The following preferred method for testing tablet hardness willsometimes be referred to herein as method number: QC-005 TABLE 9 QC-005Hardness Test Procedure APPARATUS: Van-Keel hardness tester; Pleaserefer to equipment Profile for instrument information. PROCEDURE: Laythe tablet flat with the score line side up onto the instrument inbetween the jaw area. The tablet's score line line should beperpendicular to the jaw's line for the tablet to be aligned properly.Refer to alignment diagram below. For Tamil-K caplets, place the capletonto the instrument on its side. The caplet's score line line should notbe laying on the flat part of the testing area as with other tablets butshould not be parallel to the jaw's line for the caplet to be alignedproperly. Refer to alignment diagram below. Push the test button on thecontrol panel. The jaws will automatically move the break the tablet.The force needed to break the tablet (KP) will read out on the digitaldisplay and print out on the print tape. Specifications: 6.0-14.0kiloponds RESULTS: Typical results range from about 9.3 to about 12.3kiloponds.

[0170] Generally the hardness of the pills lies between about 6.0 andabout 14.0 kiloponds. Preferably the pill hardness is from about 9 toabout 13 kiloponds. Typical results of products made in accordance withthe present invention are about 9.3, 11.3, 9.8, 10.2, 12.3, etc.Pharmaceutical tablets which incorporate granulated active ingredientare typically much higher in hardness, which may add to the difficultyof dissolving or dissoluting them. Pills which are lower in hardnessgenerally present more problems of pill fragmentation during handlingand storage.

EXAMPLE 5 Impurity Tests

[0171] The following preferred method for testing tablet impurities issometimes referenced herein as method number: SA-004 TABLE 10 SA 004Impurity Test Procedure Method Reference: Biochemie Method No. 1417-6,Report JMI-DP-002 Equipment: HPLC with a gradient system and a detectorat a wavelength of 225 nm Reagents: Acetonitrile, HPLC grade Methanol,HPLC grade Water, HPLC grade Sodium Hydroxide, ACS reagent grade SodiumHydroxide 0.1 solution: Dissolve 40 g of NaOH pellets in 1000 ml HPLCgrade water. Store in a plastic container. Phosphoric acid, 85% reagentgrade Diiodothyronine reference material Liothyronine RS USP referencematerial Levothyroxine RS USP reference material Triiodothyroacetic acidreference material Tetraiodothyroacetic acid reference material Solvent1: To 100.0 ml of 0.1 N Sodium Hydroxide solution add a 1:1 V/V mixtureof methanol and water to make 1000 ml. Solvent 2: 77:23:0.1 H2): CANACN:H3PO4; Degassed and filtered; mobile phase composition a may be alteredto achieve a satisfactory resolution factor. Extraction solution:Pipette 50 ml of solvent 1 into a 1000 ml volumetric flask dilute tovolume with solvent 2, stopper and mix well. Chromatography Nucleosil100-10CN, 250 mm long, 4.6 mm internal diameter, at ambient Column:temperature System: Gradient Elution Mobile phase A: 1000:1 H2O:H3PO4V/V Mobile phase B: Acetonitrile Gradient program: Time min % of mobilephase A % of mobile phase B  0 77 23 13 77 23 15 65 35 24 65 35 26 77 23Flow rate: 1.5 ml/min. Injection Volume: 100 up: next injection afterapprox. 40 mm. Detector: UV, 225 nm System Suitability: Chromatograph 5replicate injections of the Reference I Standard preparation,chromatograph 2 replicate injections of the Reference II Standard.Record the peak responses as directed under “Procedure”. An extractionblank is to be run after the standards. 1. The RSD must not be greaterthan 2.0% for each of the impurities in the  standard reference solutionI. 2. The resolution factor between liothyronine and levothyroxine in thestandard reference solution I must not be less than 5.0. 3. TheSignal to Noise ratio must not be less than 5/1 for levothyroxine and impurities in the chromatogram obtained with standard referencesolution  II. 4. A peak of monochlorotriiodothyronine may occur justbefore the  levothyroxine peak. Make sure that the degree of separationbetween  this peak and of levothyroxine is at least sufficient to permitseparate  evaluations. Monochlorotriiodothyronine reference material isnot  available to be purchase by any vendor. Any calculation of monochlorotriiodothyronine impurity will be done by its retention time.Standards 1. Stock Standard Reference Solution: Preparation:  Accuratelyweigh 10 mg +/− 0.1 mg of each Diiodothyronine,  Liothyronine,Levothyroxine, Triiodothyroacetic acid and  Tetraiodthyroacetic acidreference standards into a 1 OOml volumetric  flask. Dissolve in Solvent1 and dilute to volume, stopper and mix well.  The concentration of eachcomponent will be approximately  100 mcg/mlL. 2. Standard Referencesolution I:  Pipette 5.0 ml of Stock Standard Reference Solution into a100 ml  volumetric flask, dilute to volume with Solvent 2, stopper andmix well.  The Final concentration of each component will beapproximately  5 meg/mlL. 3. Standard Reference solution II (0.05%): Pipette 2.0 ml of Standard Reference Solution I into a 100 mlvolumetric  flask, dilute to volume with Solvent 2, stopper and mixwell. The final  concentration of each component will be approximately0.1  mcg/mlL. 100 Test Preparation: Crush not less than 20 tablets. Tarea 250 ml Erlenmeyer flask. Accurately weigh to the nearest 0.1 mg anequivalent of 500 meg of levothyroxine sodium (+/− 10%) into a 250 mlErlenmeyer flask. Pipette 100.0 mcg of the Extraction solution into theflask cover the flask with parafilm, sonicate, vortex and thencentrifuge the solution for 1 minute each. The final concentration ofthe sample will be approximately 5 mcg/ml of levothyroxine. To calculatethe amount to weigh for the test preparation use the following equation:${\frac{500\quad {mcg} \times 0.1450\quad g*}{{tablet}\quad {label}\quad {claim}\quad ({mcg})} = \begin{matrix}{{Amount}\quad {to}\quad {weight}} \\{{for}\quad {the}\quad {test}\quad {prep}}\end{matrix}}\quad$

*where 0.1450 g = theoretical tablet weight Note: Analyst must keep allmaterials use in performing this assay until the results are calculated,checked, and recorded and it is verified that the test is acceptable.This includes the crush, the Erlenmeyer flask with Extraction solution,the centrifuge tube and the auto-sampler vial. If the analysis isrunning overnight, these materials should be sealed with parafilm andsaved until results are obtained and the results are deemed acceptableProcedure: 1. Separately inject 100 μl of the sample preparation ontothe column. Record  the response of the analyte peaks and the calculate% w/w using the  equations below. 2. The chromatogram may need to bereprocessed to obtain optimal  integration. A copy of the samplechromatograph is to be attached to the  analytical packet. 3. Peaks onthe sample chromatograph with areas less than a  signal ratio of 5/1will be considered none detected.

[0172] Calculations: Diiodothyronine:${\frac{{Sample}\quad {area}}{\quad {{Std}.\quad {Area}}} \times \frac{{Std}\quad {{Conc}.\quad ({mcg})}}{ml} \times \frac{100\quad {ml}}{{Wsimpl}\quad (g)} \times \frac{100\%}{1000000\quad {{mcg}/g}} \times 1.11^{*}} = {\% \quad {w/w}}$

or Sample area × Std. Conc. (mcg) × 0.01 × 1.11* = % w/w *where 1.11 isa correction factor Triiodothyroacetic Acid:${\frac{{Sample}\quad {area}}{{Std}.\quad {Area}} \times \frac{{Std}\quad {{Conc}.\quad ({mcg})}}{ml} \times \frac{100\quad {ml}}{{Wsimpl}\quad (g)} \times \frac{100\%}{1000000\quad {{mcg}/g}}} = {\% \quad {w/w}}$

or${\frac{{Sample}\quad {area}}{\quad {{Std}.\quad {Area}}} \times \frac{{Std}\quad {{Conc}.\quad ({mcg})}}{ml} \times \frac{0.01}{{Wsimpl}\quad (g)}} = {\% \quad {w/w}}$

Tetraiodothyroacetic Acid:${\frac{{Sample}\quad {area}}{\quad {{Std}.\quad {Area}}} \times \frac{{Std}\quad {{Conc}.\quad ({mcg})}}{ml} \times \frac{100\quad {ml}}{{Wsimpl}\quad (g)} \times \frac{100\%}{1000000\quad {{mcg}/g}} \times 1.16^{*}} = {\% \quad {w/w}}$

or${\frac{{Sample}\quad {area}}{{Std}.\quad {Area}} \times \frac{{Std}\quad {{Conc}.\quad ({mcg})}}{ml} \times \frac{0.01\quad}{{Wsimpl}\quad (g)} \times 1.16^{*}} = {\% \quad {w/w}}$

*where 1.16 is a correction factor

[0173] Limit of Detection (LOD) Values Impurity Limit of DetectionDiiodothyronine (T2)  0.00625% Triiodothyroacetic Acid (Reverse T3)0.003125% Tetraiodothyroacetic Acid (Reverse T4) 0.003125%

[0174] Calculation of the theoretical area for 0.05% of levothyroxinesodium, based on the initial amount in mg of levathyroxine sodium in thewhole sample weight.$\frac{\left( {{Area}\quad {rs}\quad {II}} \right)(A)(10.0)}{({.05})\left( {T_{4}{std}\quad {{st}.}} \right)(P)(1.0283)} = \begin{matrix}{{{Theoretical}\quad {area}\quad {for}\quad 0.05\% \quad {of}\quad {levothyroxine}\quad {Na}},\quad {based}} \\{{on}\quad {the}\quad {actual}\quad {weight}}\end{matrix}$

[0175] Where:

[0176] Area_(rs)—is the average area of the levothyroxine in theStandard reference solution II

[0177] A=is the initial weight of levothyroxine Na in mg represented bythe sample weight.

[0178] This is calculated by using this equation:${{This}\quad {is}\quad {calculated}\quad {by}\quad {using}\quad {this}\quad {equation}}:=\frac{{sample}\quad {weight}\quad (g) \times {claim}\quad T_{4}\quad {in}\quad {mcg}}{0.1450\quad g \times 1000\quad {{mcg}/{mg}}}$

[0179] 10.0=theoretical initial weight of the Levothyroxine USPreference standard

[0180] 0.500=is the theoretical initial weight of the Levothyroxine NAto be tested, in mg

[0181] T₄ std. Wt.=the initial weight of the levothyroxine USP standardin mg

[0182] P=the purity of the levothyroxine Na USP standard (% purity/100%)

[0183] 1.0283=conversion of levothyroxine into levothyroxine sodium

[0184] Greatest unknown impurity (individually):$\frac{\left( {Area}_{impurity} \right)\left( {T_{4}{std}\quad {wt}\quad {mg}} \right)(1.0283)(P)(100)}{\left( {{Area}\quad {ref}\quad {std}\quad I} \right)(A)(2000)} = {{impurity}\quad (\%)}$

[0185] Where:

[0186] Area _(impurity) is the area of the greatest unknown impurity inthe test solution with an area greater than the theoretical area for0.05% of the levothyroxine Na taken into account.

[0187] 1.0283=conversion of levothyroxine into levothyroxine sodium

[0188] P=the purity of the levothyroxine Na USP standard (% purity/100%)

[0189] 100 is the dilution of the test solution

[0190] Area ref std I is the area of the levothyroxine in the standardreference solution I

[0191] A=is the initial weight of levothyroxine Na in mg represented bythe sample weight.

[0192] This is calculated by using this equation:${{This}\quad {is}\quad {calculated}\quad {by}\quad {using}\quad {this}\quad {equation}}:=\frac{{sample}\quad {weight}\quad (g) \times {claim}\quad {T4}\quad {in}\quad {mcg}}{0.1450\quad g \times 1000\quad {{mcg}/{mg}}}$

[0193] 2000 is the dilution of the reference solution.

[0194] Total of Other Unknown Impurities:$\frac{\left( {{Sum}\quad {area}\quad {impurities}} \right)\left( {{T4}\quad {std}\quad {wt}\quad {mg}} \right)(1.0283)(P)(100)}{\left( {{are}\quad {ref}\quad {std}\quad I} \right)(A)(2000)} = {{Total}\quad {Unknown}\quad {impurities}\quad (\%)}$

[0195] Where:

[0196] Sum area impurity is the sum of the areas of all the otherunknown impurities in the test solution (only areas that are greaterthan the theoretical area for 0.05% of the levothryoxine sodium takeninto account)

[0197] T4 std. wt.=the initial weight of the levothyroxine USP standardin mg

[0198] 1.0283=conversion of levothyroxine into levothyroxine sodium

[0199] P=the purity of the levothyroxine Na USP standard (%pursity/100%)

[0200] 100 is the dilution of the test solution

[0201] Area ref std I is the area of the levothyroxine in the standardreference solution I

[0202] A=is the initial weight of levothyroxine Na in mg represented bythe sample weight.

[0203] This is calculated by using this equation:${{This}\quad {is}\quad {calculated}{\quad \quad}{by}\quad {using}\quad {this}\quad {equation}}:=\frac{{sample}\quad {weight}\quad (g) \times {claim}\quad {T4}\quad {in}\quad {mcg}}{0.1450\quad g \times 100\quad {{mcg}/{mg}}}$

[0204] 2000 is the dilution of the reference solution.

[0205] Results of the test are shown in FIGS. 6A and 6B. FIG. 6A showsan example of a chromatogram of Standard Reference Solution II, withexemplary peaks at about 5.4 for diiodo-1-thyronine, 8.4 forliothryonine, 12.8 for levothyroxine, 19.3 for triiodo thyroacetic acid,and 21.9 for tetraiodo thyroacetic acid. FIG. 6B shows results of anexperimental sample of levothyroxine sodium, made in accordance withthis invention. As can be seen, the sample had substantially onlylevothyroxine, with insignificant impurities.

EXAMPLE 6 Liothyronine (T3) Tests

[0206] The following preferred method for testing for Triiodothyronineis sometimes referenced herein as method number: QC-001 TABLE 11 QC-001T3 Test Procedure Method Reference USP 24 p. 968-970 Chromatographic65:35:0.05 H₂O:CACN:H₃PO₄ degassed and filtered; mobile phaseConditions: composition may be altered to achieve a satisfactoryresolution factor. Mobile Phase: Column: CN, 4.6 mm × 25 to 30 cm FlowRate: 2.0 minute/minute Detector: Deuterium, set at 225 nm InjectionVolume: 100 μL System Suitability: Chromatograph 5 replicate injectionsof the standard preparation. Record the peak responses as directed under“Procedure”. 1.0 RSD for the standard replicates must not be more than2.0% for T₄ 2.0 Calculate the resolution factor (R) on one of the fivereplicates. The R value must be greater than or equal to proceed. SeeMethod QC-009. Standard Preparation: Accurately weigh 25 mg of USPLevothyroxine RS and transfer to a clear 250-mlL volumetric flask.Pipette 87.5 ml minute of acetonitrile in the flask. Swirl and thensonicate for less than a minute. Add portions of HPLC grade water to theflask with swirling and sonicating until the material has gone intosolution. Be sure that there is no particulate material present. Do notdilute to volume at this point. The solution may be cold. Place into aroom temperature water bath for ten minutes to allow the sample to warmto ambient temperature. Dilute to volume with HPLC grade water. Mixwell. Label this solution as stock T₄ The concentration of T₄ is about100 μg/ml. Also dissolve an accurately weighed quantity of USPLiothyronine RS to yield about 100 μg/minute, done as above with USPLevothyroxine RS. Label this solution as stock T₃-A. Stock Standarddilution: 1. Pipette 10.0 ml stock T₃-A into a 500-mlL Type A volumetricflask. 2. Dilute to volume with Mobile Phase for a concentration ofabout 2 μg/ml. Mix well and label this solution as stock std. c-B. 3.Pipette 50.0 ml each from the T₄ and T₃ stock standards and transferinto 500-mlL Type A volumetric flask. Dilute to volume with mobile phaseand mix well. Label this standard as T₃/T₄ working standard. Theconcentration of the working standard should be about 0.2 μg/ml T₃ and10.0 μg/ml T₄. Assay Preparation: Weigh and crush not less than thespecified tablet quantity and calculate the average tablet weight. Tarea polypropylene weigh boat. Accurately weigh (to 0.1 mg) a portion ofthe powder into the tared weigh boat using a preconditioned stainlesssteel scoop or spatula (either Teflon coated or uncoated). The spatulaor scoop is preconditioned by dipping it into the power. Use the SampleCalculation below to achieve 50 ml of a 10 μg/ml assay solution. Recordthe sample weight taken. Carefully transfer the sample into anErlenmeyer flask, reweigh the weigh boat and subtract the residualweight from the weight taken to obtain the actual sample weight. Pipette50 ml of mobile phase into the flask. Cover the flask with parafilm,sonicate for approximately 10 seconds and vortex for approximately 35seconds at a speed of 6 or greater. Observe sample preparation, and ifclumping is noted, repeat the sonication and/or vortex steps. Centrifuge(˜3,000 rpm) for NLT 1 minute until a clear supernatant is achieved.Transfer a portion of the supernatant to an autosampler vial. ForIn-Process granulation analysis, use the theoretical tablet weight(0.1455 g) in place of (weight of tablets/number of tablets) in theformula below. Note Analyst must keep all materials used in performingthis assay until the results are calculated, checked, and recorded, andit is verified that the test is acceptable. This includes the crush, theErlenmeyer flask with Mobile Phase, the centrifuge tube and theautosampler vial. If the analysis is running overnight, these materialsshould be sealed with parafilm and saved until results are obtained andthe result is deemed acceptable.

[0207] Sample Calculation:${\frac{{Weight}\quad {of}\quad {Tablets}}{{Number}\quad {of}\quad {Tablets}} \times 10\quad {{\mu g}/{ml}} \times \frac{50\quad {ml}}{{Dose}\quad ({\mu g})}} = \begin{matrix}{{Amount}\quad {of}\quad {Weigh}\quad {Out}\quad {per}} \\{{Assay}\quad}\end{matrix}$

Procedure: Separately inject 100 μl of the sample onto the column.Record the responses of the analyte peak. Calculations: Calculate thecontent of liothyronine using the following formula:${\frac{{Sample}\quad T_{3}\quad {Area}}{{Standard}\quad T_{3}\quad {Area}} \times \frac{{Std}\quad T_{3}\quad {{conc}.\quad ({\mu g})}}{({ml})} \times 50\quad {ml}} = {{\mu g}\quad T_{3}}$

The specification is NGT 2.0% liothyronine calculated as follows:${\frac{{Amt}\quad T_{3}\quad {Assayed}\quad ({ug})}{{Amt}\quad T_{4}\quad {Assayed}\quad ({ug})^{*}} \times 100} = {\% \quad {LIOTHYRONINE}}$

*This number is calculated using the T₄ potency results as follows:${\frac{{Sample}\quad T_{4}\quad {Area}}{{Standard}\quad T_{4}\quad {Area}} \times \frac{{Std}\quad T_{4}\quad {{conc}.\quad ({\mu g})}}{({ml})} \times 50\quad {ml} \times \frac{798.86}{776.87}} = {{\mu g}\quad T_{4}}$

where 798.86 = molecular weight of Levothyroxine as the Sodium Salt776.87 = molecular weight of Levothyroxine Standard Base

[0208] METHOD: USP 24 <905> pp. 2000-2002. METHOD A: Content Uniformityas Determined by Weight Variation: Weight accurately 10 tablets,individually. From the results of the average potency of the activeingredient determined for the product (using the assay methods as statedin the individual monograph) calculate the content of active ingredientin each of the 10 tablets. CALCULATIONS: $\begin{matrix}{Individual} \\{Potency}\end{matrix} = \frac{\left( {{Avg}.\quad {potency}} \right)\quad \left( {{Individual}\quad {{Wt}.}} \right)}{{{Avg}.\quad {tablet}}\quad {weight}}$

NOTE: If the active ingredient(s) are less than 50% by weight of thetablet content, refer to the individual test method for potency forthose products. METHOD B: Content Uniformity as Determined by DirectAssay of Active Ingredient: For Levothyroxine Sodium tablets thefollowing procedure is followed. Individually weigh 10 tablets. Placethe 10 individual tablets into round bottomed test tubes or flasks ofthe appropriate size as outlined in the chart below. Add the appropriatevolume of extraction mobile comprised of water, acetonitrile, andphosphoric acid (65:35::0.05) to each test tube or flask as indicated inthe chart below. Note: All test tubes are to be capped with screw oncaps and all flasks are to be covered with parafilm as soon as mobilephase is added. Allow to stand at room temperature until the tabletcompletely crumbles. Secure all samples in a wrist action shaker. Testtubes are to be secured horizontally. Erlenmeyer flasks are to besecured vertically. Set the wrist shaker to the setting specified in thetable. Shake sample for 3 minutes. Transfer about 10 ml of the samplepreparation (or the entirety of smaller samples) to a centrifuge tube.Centrifuge samples for 1 minute at about 3000 rpm. Transfer samples toautosampler vials using disposable Pasteur pipettes. Utilize the HPLCMethod for levothyroxine separation (AM-003) for obtaining dosageuniformity, sample area, and standard area results. CALCULATIONS: DosageUniformity Result (% Label Claim)${{\frac{798.86}{776.87} \times \frac{{Area}\quad {of}\quad {Sample}}{{Area}\quad {of}\quad {{Std}.}} \times \frac{{{Conc}.\quad {of}}\quad {{Std}.}}{{{Conc}.\quad {Of}}\quad {Sample}} \times 100} = \begin{matrix}{\% \quad {Potency}} \\\left( {{see}\quad {chart}\quad {below}} \right)\end{matrix}}\quad$

[0209] SPECIFICATIONS FOR METHOD A OR METHOD B S-1 The % activeingredient for 10 tablets tested must fall in the range of 85.0%-115.0%and the RSD of the 10 tablets must not exceed 6.0%. NOTE: If 1 unit inS-1 fails to meet either of the specifications, but is no outside therange of 75%-125%, test 20 more units and proceed to S-2. S-2 When n =30, NGT one unit outside 85.0-115.0%, none outside 75.0-125.0% and RSDNGT 7.80%.

[0210] Results

[0211] Results for a variety of dosages, using a sample size of 120pills, are shown in Table 12: TABLE 12 Dosage Consistency - 120 pillsamples Dosage 25 μg 100 μg 300 μg Label Claim 103.5% 103.1% 102.9%Activity High 109.1% 104.8% 108.8% Low 98.0% 100.7% 96.5% RSD < 2.0%0.9% 2.2%

[0212] The results confirm an extremely low amount of variability inactive material content between the 120 pills tested. Generally thevariability for a 120 pill sample should be between about 90 and about110% of claimed activity, preferably between about 95% and about 105%.The RSD for a 120 pill sample should not be greater than 5%, andpreferably is less than 3%.

EXAMPLE 7 Levothyroxine Sodium Release Specification and AnalyticalMethods

[0213] The specifications for levothyroxine sodium tablets are statedin: USP 24 page 969-970 and Supplement 1 page 2638. The additionalrequirements are in place to ensure the tablet appearance, for theindividual tablet strengths, is correct and the physical characteristicsensure a quality tablet.

[0214] A. Analytical Methods

[0215] All the test methods utilized in the testing of levothyroxinesodium meet USP system suitability requirements. All Levoxyl® batchesare tested for conformance to the following specifications. The Table 13below lists the test parameter, specification and the test methodemployed. TABLE 13 USP Specifications Test Test Parameter SpecificationMethod Tablet Potency 90.0-110.0% label claim* AM-003 Tablet DissolutionNULT 7580% label claim dissoluted in 145 minutes AM-004B LiothyronineNGT 2.0% QC-001 Content TLC Identification Compares to Standard RM-054Uniformity of S-1: 85.0-115.0% RSD NGT 6.0% n=10 QC-003 Dosage Units (ifNGT 1 unit fails, but no unit is outside range of 75.0-125.0% or if RSDfails proceed to S-2) S-2: When n=30 NGT 1 unit outside 85.0-115.0%,none outside 75.0-125 .0% and RSD NGT 7.8% Additional Requirements:Tablet Hardness  6.0-14.0 KP QC-005 Tablet Weight 142.0-149.0 mg QC-007Tablet Appearance Color, imprint, score line and shape conform tospecific QC-008 tablet parameters as specified for the individualstrengths

EXAMPLE 8 Bioavailability Determination of Two LevothyroxineFormulations

[0216] The following example was performed along lines of a 1999 FDApublication entitled In-Vivo Pharmacokinetics and BioavailabilityStudies and In-Vitro Dissolution Testing for Levothyroxine SodiumTablets. The example includes the following two studies.

[0217] Study 1. Single-Dose Bioavailability Study

[0218] The objective of the study was to determine the bioavailabilityof Levoxyl® relative to a reference (oral solution) under fastingconditions.

[0219] Study 2: Dosage-Form Equivalence Study

[0220] The objective of the study was to determine the dosage-formbioequivalence between three different strengths of Levoxyl® tablets(low, middle and high range).

[0221] Study Objective

[0222] To determine the bioavailability of levothyroxine sodium(Levoxyl®) 0.3 mg tablets manufactured by JONES PHARMA INCORPORATED,relative to Knoll Pharmaceutical Company's levothyroxine sodium 200 g(Synthroid®) injection given as an oral solution following a single 0.6mg dose.

[0223] Study Methodology

[0224] Single-dose, randomized, open-label, two-way crossover design

[0225] Protocol Reference

[0226] Guidance for Industry: In Vivo Pharmacokinetics andBioavailability Studies and In Vitro Dissolution Testing forLevothyroxine Sodium Tablets (June 1999).

[0227] Number of Subjects

[0228] A total of 30 subjects were enrolled in the study, and 27subjects completed the study. All 30 subjects were included in thesafety analysis and 27 subjects who completed the study were included inthe pharmacokinetic analyses.

[0229] Diagnosis and Main Criteria for Inclusion

[0230] All subjects enrolled in this study were judged by theinvestigator to be healthy volunteers who met all inclusion andexclusion criteria.

[0231] Test Product, Dose, Duration, Mode of Administration, and BatchNumber

[0232] The test product was levothyroxine sodium (Levoxyl®) 2×0.3 mgtablets administered as a single oral dose. The batch number utilized inthis study was TT26.

[0233] Reference Product, Dose, Duration, Mode of Administration, andBatch Number

[0234] The reference product was levothyroxine sodium (Synthroid®) 2×500μg injection vials (Knoll Pharmaceutical Company) reconstituted and 600μg administered orally. The reference product used was the 500 μginjection instead of 200 μg due to the unavailability of sufficientquantities of 200 μg injection to conduct the study. The batch numberutilized in this study was 80130028.

[0235] Criteria for Evaluation

[0236] Pharmacokinetics

[0237] Pharmacokinetic assessment consisted of the determination oftotal (bound+free) T4 and T3 concentrations in serum at specified timepoints following drug administration. From the serum data, theparameters AUC(0-t), Cmax, and Tmax were calculated.

[0238] Safety

[0239] Safety assessment included vital signs, clinical laboratoryevaluation (including TSH), physical examination, and adverse events(AEs) assessment.

[0240] Statistical Methods

[0241] Pharmacokinetics

[0242] Descriptive statistics (arithmetic mean, standard deviation (SD),coefficient of variation (CV), standard error of the mean (SE), samplesize (N), minimum, and maximum) were provided for all pharmacokineticparameters. The effects of baseline and baseline-by treatmentinteraction were evaluated using a parametric (normal-theory) generallinear model (ANCOVA) with treatment, period, sequence, subject withinsequence, In(baseline), and interaction between In (baseline) andtreatment as factors, applied to the In-transformed pharmacokineticparameters and Cmax. In the absence of significant In(baseline) andinteraction between In(baseline) and treatment, these parameters wereremoved from the model. The two one-sided hypotheses were tested at the5% level of significance for In[AUC(0-t)] and In(Cmax) by constructing90% confidence intervals for the ratio of Treatment A to Treatment

[0243] Safety

[0244] Frequency counts of all subjects enrolled in the study,completing the study, and discontinuing early were tabulated.Descriptive statistics were calculated for continuous demographicvariables, and frequency counts were tabulated for categoricaldemographic variables for each gender and overall.

[0245] AEs were coded using the 5^(th) Edition of the COSTARTdictionary. AEs were summarized by the number and percentage of subjectsexperiencing each coded event. A summary of the total number of eachcoded event and as a percentage of total AEs was also provided.

[0246] Laboratory summary tables included descriptive statistics forcontinuous serum chemistry and hematology results at each time point.Out-of-range values were listed by subject for each laboratoryparameter.

[0247] Descriptive statistics for vital sign measurements at each timepoint and change from baseline to each time point were calculated bytreatment group. Shifts from screening to post study results forphysical examinations were tabulated.

[0248] Pharmacokinetic Results—T4

[0249] ANCOVA analyses indicated that the effects of In(baseline) andinteraction between In(baseline) and treatment were not significant.Thus, these factors were removed from the general linear model and anANOVA with treatment, period, sequence, and subject within sequence wasapplied to the In-transformed Cmax and AUC(0-t) parameters. Thearithmetic means of serum T4 pharmacokinetic parameters for Treatments Aand B and the statistical comparison for In-transformed parameters aresummarized in the following table. Summary of the PharmacokineticParameters of Serum T4 for Treatments A and B Treatment A* Treatment B**Pharmacokinetic Arithmetic Arithmetic 90% % Mean Parameters Mean SD MeanSD CI Ratio Cmax (u g/dlL) 14.48 1.93 15.09 2.10 — — Tmax (hr) 2.170.810 1.62 0.502 — — AUC(0-t) ( g * hr/dl) 524.3 59.07 529.3 62.83 — —In (Cmax) 2.663 0.1434 2.705 0.1339 91.1-98.1 94.5 In [AUC(0-t)] 6.2560.1167 6.265 0.1169  95.6-100.5 98.0

[0250] Pharmacokinetic Results—T3

[0251] ANCOVA analyses indicated that the effects of In(baseline) andinteraction between In(baseline) and treatment were not significant andwere removed from the ANOVA model, except for In(baseline) on In(Cmax)which was significant and was kept in the model. An ANOVA withtreatment, period, sequence, and subject within sequence, andIn(baseline), when significant, was applied to the In-transformed Cmaxand AUC(0-t) parameters. The arithmetic means of serum T3pharmacokinetic parameters for Treatments A and B and the statisticalcomparison for In-transformed parameters are summarized in the followingtable. Summary of the Pharmacokinetic Parameters of Serum T3 forTreatments A and B Treatment A* Treatment B** Pharmacokinetic ArithmeticArithmetic 90% % Mean Parameters Mean SD Mean SD CI Ratio Cmax (ng/ml)1.165 0.156 1.140 0.119 — — Tmax (hr) 14.6 15.2 16.3 17.0 — — AUC(0-t)(ng * hr/ml) 51.25 6.163 50.07 5.311 — — In (Cmax) 0.1444 0.1289 0.12550.1034 96.8-103.4 100.0 In [AUC(0-t)] 3.930 0.1209 3.908 0.105997.7-103.8 100.7

[0252] Comparison of total T4 and T3 pharmacokinetics followingadministration of Levoxyl® (Treatment A, test formulation) and Synthroid(Treatment B, reference formulation) indicated that the test formulationmet the requirements for bioequivalence with the reference formulation.

[0253] The 90% confidence intervals for the comparisons of In(Cmax) andIn[AUC(0-t)] for T4 and T3 were within the 80% to 125% range requiredfor bioequivalence.

[0254] In regard to subject safety, both treatments appeared to beequally safe and well tolerated.

EXAMPLE 9 Bioavailability Study to Assess Single Dose Bioequivalence ofThree Strengths of Levothyroxine

[0255] The following example was performed to determine the dosage-formbioequivalence between three different strengths of levothyroxine sodium(Levoxyl®) tablets following a single 600 mcg dose.

[0256] Study Methodology

[0257] Single-dose, randomized, open-label, three-way crossover design.

[0258] Protocol Reference

[0259] Guidance for Industry: In Vivo Pharmacokinetics andBioavailability Studies and In Vitro Dissolution Testing forLevothyroxine Sodium Tablets (June 1999). This protocol was submitted inIND 59,177.

[0260] Number of Subjects

[0261] A total of 28 subjects were enrolled in the study, and 24subjects completed the study. All 28 subjects were included in thesafety analysis and 24 subjects who completed the study were included inthe pharmacokinetic analyses.

[0262] Diagnosis and Main Criteria for Inclusion

[0263] All subjects enrolled in this study were judged by theinvestigator to be healthy volunteers who met all inclusion andexclusion criteria.

[0264] Test Product, Dose, Duration, Mode of Administration, and BatchNumber

[0265] Subjects randomized to Treatment A received a single oral dose of12×50 mcg levothyroxine sodium (Levoxyl®) tablets, Lot No. TT24.Subjects randomized to Treatment B received 6×100 mcg levothyroxinesodium (Levoxyl®) tablets, Lot No.TT25. Subjects randomized to TreatmentC received 2×300 mcg levothyroxine sodium (Levoxyl®) tablets, Lot No.TT26. Test products were manufactured by JMI-Daniels, a subsidiary ofJones Pharma Incorporated.

[0266] Pharmacokinetics

[0267] Pharmacokinetic assessment consisted of the determination oftotal (bound+free) T4 and T3 concentrations in serum at specified timepoints following drug administration. From the serum data, theparameters AUC(0-t), Cmax, and Tmax were calculated.

[0268] Safety

[0269] Safety assessment included monitoring of sitting vital signs,clinical laboratory measurements, thyroid-stimulating hormone (TSH),physical examination, electrocardiogram (ECG), and adverse events (AEs).

[0270] Statistical Methods

[0271] Pharmacokinetics

[0272] Descriptive statistics (arithmetic mean, standard deviation (SD),coefficient of variation (CV), standard error of the mean (SEM), samplesize (N), minimum, and maximum) were provided for all pharmacokineticparameters. A parametric (normal-theory) general linear model withtreatment, period, sequence, and subject within sequence as factors wasapplied to the In-transformed Cmax and AUC(0-t). The two one-sidedhypotheses were tested at the 5% level of significance for In[AUC(0-t)]and In(Cmax) by constructing 90% confidence intervals for the ratios ofTreatment A to Treatment B, Treatment A to Treatment C, and Treatment Bto Treatment C.

[0273] Safety

[0274] Frequency counts of all subjects enrolled in the study,completing the study, and discontinuing early were tabulated.Descriptive statistics were calculated for continuous demographicvariables, and frequency counts were tabulated for categoricaldemographic variables for each gender and overall.

[0275] AEs were coded using the 5^(th) Edition of the COSTARTdictionary. AEs were summarized by the number and percentage of subjectsexperiencing each coded event. A summary of the total number of eachcoded event and as a percentage of total AEs was also provided.Laboratory summary tables included descriptive statistics for continuousserum chemistry and hematology results at each time point. Out-of-rangevalues were listed by subject for each laboratory parameter. Descriptivestatistics for vital sign measurements at each time point and changefrom baseline to each time point were calculated by treatment group.Shifts from screening to post study results for physical examinationswere tabulated.

[0276] Pharmacokinetic Resulta—T4

[0277] The arithmetic means of serum T4 pharmacokinetic parameters forTreatments A and B and the statistical comparison for the In-transformedparameters are summarized in the following table. Summary of thePharmacokinetic Parameters of Serum T4 for Treatments A and B TreatmentA* Treatment B** Pharmacokinetic Arithmetic Arithmetic % Mean ParametersMean SD Mean SD 90% CI Ratio Cmax (μg/dl) 13.70 1.82 14.13 1.48 — — Tmax(hr) 2.37 1.04 1.98 0.827 — — AUC(0-t) ( g * hr/dl) 509.0 58.36 528.372.41 — — In (Cmax) 2.609 0.1378 2.643 0.1095 93.6-100.1 96.8 In[AUC(0-t)] 6.226 0.1200 6.261 0.1379 93.4-100.0 96.7

[0278] The arithmetic means of serum T4 pharmacokinetic parameters forTreatments A and C and the statistical comparison for the In-transformedparameters are summarized in the following table. Summary of thePharmacokinetic Parameters of Serum T4 for Treatments A and C TreatmentA* Treatment C** Pharmacokinetic Arithmetic Arithmetic % Mean ParametersMean SD Mean SD 90% CI Ratio Cmax ( g/d) 13.70 1.82 14.15 1.50 — — Tmax(hr) 2.37 1.04 2.40 1.09 — — AUC(0-t) ( g * hr/dL1) 509.0 58.36 528.757.13 — — In (Cmax) 2.609 0.1378 2.644 0.1085  93.6-100.1 96.8 In[AUC(0-t)] 6.226 0.1200 6.265 0.1089 93.1-99.7 96.4

[0279] The arithmetic means of serum T4 pharmacokinetic parameters forTreatments B and C and the statistical comparison for the In-transformedparameters are summarized in the following table.

[0280] Pharmacokinetic Results—T4 (Continued) Summary of thePharmacokinetic Parameters of Serum T4 for Treatments B and C TreatmentB* Treatment C** Pharmacokinetic Arithmetic Arithmetic % Mean ParametersMean SD Mean SD 90% CI Ratio Cmax ( g/d) 14.13 1.48 14.15 1.50 — — Tmax(hr) 1.98 0.827 2.40 1.09 — — AUC(0-t) ( g * hr/dl) 528.3 72.41 528.757.13 — — In (Cmax) 2.643 0.1095 2.644 0.1085 96.7-103.4 100.0 In[AUC(0-t)] 6.261 0.1379 6.265 0.1089 96.4-103.1  99.7

[0281] Pharmacokinetic Results—T3

[0282] The arithmetic means of serum T3 pharmacokinetic parameters forTreatments A and B and the statistical comparison for the In-transformedparameters are summarized in the following table. Summary of thePharmacokinetic Parameters of Serum T3 for Treatments A and B TreatmentA* Treatment B** Pharmacokinetic Arithmetic Arithmetic % Mean ParametersMean SD Mean SD 90% CI Ratio Cmax (ng/ml) 1.173 0.138 1.142 0.133 — —Tmax (hr) 12.9 19.0 12.1 16.1 — — AUC(0-t) (ng * hr/ml) 49.43 6.87250.35 8.994 — — In (Cmax) 0.1523 0.1226 0.1264 0.1194 98.1-107.3 102.6In[AUC(0-t)] 3.890 0.1538 3.905 0.1731 93.1-104.3  98.5

[0283] The arithmetic means of serum T3 pharmacokinetic parameters forTreatments A and C and the statistical comparison for the In-transformedparameters are summarized in the following table.

[0284] Pharmacokinetic Results—T3 (Continued) Summary of thePharmacokinetic Parameters of Serum T3 for Treatments A and C TreatmentA* Treatment C** Pharmacokinetic Arithmetic Arithmetic % Mean ParametersMean SD Mean SD 90% CI Ratio Cmax (ng/ml) 1.173 0.138 1.167 0.169 — —Tmax (hr) 12.9 19.0 11.5 16.4 — — AUC(0-t) (ng * hr/ml) 49.43 6.87249.36 7.680 — — In (Cmax) 0.1523 0.1226 0.1437 0.1491 96.3-105.4 100.7In [AUC(0-t)] 3.890 0.1538 3.886 0.1705 94.7-106.2 100.3

[0285] The arithmetic means of serum T3 pharmacokinetic parameters forTreatments B and C and the statistical comparison for the In-transformedparameters are summarized in the following table. Summary of thePharmacokinetic Parameters of Serum T3 for Treatments B and C TreatmentB* Treatment C** Pharmacokinetic Arithmetic Arithmetic % Mean ParametersMean SD Mean SD 90% CI Ratio Cmax (ng/ml) 1.142 0.133 1.167 0.169 — —Tmax (hr) 12.1 16.1 11.5 16.4 — — AUC(0-t) (ng * hr/ml) 50.35 8.99449.36 7.680 — — In (Cmax) 0.1264 0.1194 0.1437 0.1491 93.9-102.7  98.2In [AUC(0-t)] 3.905 0.1731 3.886 0.1705 96.2-107.8 101.8

[0286] Safety Results

[0287] There was a total of 59 treatment-emergent AEs reported by 15(54%) of the 28 subjects dosed with study treatment. Incidence of AEswas similar across treatments. Headache was the most frequently reportedevent. The majority of the AEs were mild in intensity. There was onesubject who experienced a serious adverse event of chest pain,considered by the Investigator to be unrelated to treatment. No trendswere noted in vital signs, clinical laboratory results, or ECGs tosuggest treatment-related differences.

[0288] Comparison of total T4 and T3 pharmacokinetics followingadministration of 12×50 mcg Levoxyl® tablets (Treatment A) and 6×100 mcgLevoxyl® tablets (Treatment B) indicated that the two formulations metthe requirements for bioequivalence. The 90% confidence intervals forthe comparisons of In(Cmax) and In[AUC(0-t)] for T4 and T3 were withinthe 80% to 125% range required for bioequivalence.

[0289] Comparison of total T4 and T3 pharmacokinetics followingadministration of 12×50 mcg Levoxyl® tablets (Treatment A) and 2×300 mcgLevoxyl® tablets (Treatment C) indicated that the two formulations metthe requirements for bioequivalence. The 90% confidence intervals forthe comparisons of In(Cmax) and In[AUC(0-t)] for T4 and T3 were withinthe 80% to 125% range required for bioequivalence.

[0290] Comparison of total T4 and T3 pharmacokinetics followingadministration of 6×100 mcg Levoxyl® tablets (Treatment B) and 2×300 mcgLevoxyl® tablets (Treatment C) indicated that the two formulations metthe requirements for bioequivalence. The 90% confidence intervals forthe comparisons of In(Cmax) and In[AUC(0-t)] for T4 and T3 were withinthe 80% to 125% range required for bioequivalence.

[0291] The test formulations appear to be safe and generally welltolerated when given to healthy adult volunteers.

EXAMPLE 10 Levothyroxine Sodium (Levoxyl®) Tablet Compositions

[0292] The following preferred levothroxine sodium compositions intablet form were made along lines disclosed herein. Levoxyl ® 25 mcgTablets Color: orange; Markings: (front) dp/25 (back) LEVOXYL ®Component Quantity in mg/Tablet Levothyroxine Sodium, USP  0.025 mgβ-Form Microcrystalline Cellulose, NF (Ceolus) 108.529 mg CroscarmelloseSodium, NF (Ac-di-sol)  35.079 mg FD&C Yellow # 6  0.352 mg MagnesiumStearate, NF  1.018 mg

[0293] Levoxyl ® 50 mcg Tablets Color: white; Markings: (front) dp/50(back) LEVOXYL ® Component Quantity in mg/Tablet Levothyroxine Sodium,USP  0.050 mg β-Form Microcrystalline Cellulose, NF (Ceolus) 108.856 mgCroscarmellose Sodium, NF (Ac-di-sol)  35.079 mg Magnesium Stearate, NF 1.018 mg

[0294] Levoxyl ® 75 mcg Tablets Color: purple; Markings: (front) dp/75(back) LEVOXYL ® Component Quantity in mg/Tablet Levothyroxine Sodium,USP  0.075 mg β-Form Microcrystalline Cellulose, NF (Ceolus) 108.438 mgCroscarmellose Sodium, NF (Ac-di-sol)  35.079 mg Lake Blend # LB-1609 0.383 mg (Blend of D&C Red # 30 and FD&C Blue # 1) Magnesium Stearate,NF  1.018 mg

[0295] Levoxyl ® 88 mcg Tablets Color: olive; Markings: (front) dp/88(back) LEVOXYL ® Component Quantity in mg/Tablet Levothyroxine Sodium,USP 0.088 mg β- Form Microcrystalline Cellulose, NF (Ceolus) 108.311 mgCroscarmellose Sodium, NF (Ac-di-sol) 35.079 mg Lake Blend # LB-16070.507 mg (Blend of FD&C Yellow # 6, D&C Red # 30 and FD&C Blue # 1)Magnesium Stearate, NF 1.018 mg

[0296] Levoxyl ® 100 mcg Tablets Color: yellow; Markings: (front) dp/100(back) LEVOXYL ® Quantity in mg/ Component Tablet Levothyroxine Sodium,USP 0.100 mg β- Form Microcrystalline Cellulose, NF (Ceolus) 108.406 mgCroscarmellose Sodium, NF (Ac-di-sol) 35.079 mg Lake Blend # LB-282(Blend of FD&C Yellow # 6 0.388 mg and D&C Yellow # 10) MagnesiumStearate, NF 1.018 mg

[0297] Levoxyl ® 112 mcg Tablets Color: rose; Markings: (front) dp/112(back) LEVOXYL ® Quantity in mg/ Component Tablet Levothyroxine Sodium,USP 0.112 mg β- Form Microcrystalline Cellulose, NF (Ceolus) 107.711 mgCroscarmellose Sodium, NF (Ac-di-sol) 35.079 mg Lake Blend # LB-1610(Blend of FD&C Yellow # 6, 1.080 mg D&C Red # 30 and FD&C Red # 40)Magnesium Stearate, NF 1.018 mg

[0298] Levoxyl ® 125 mcg Tablets Color: brown; Markings: (front) dp/125(back) LEVOXYL ® Quantity in mg/ Component Tablet Levothyroxine Sodium,USP 0.125 mg β- Form Microcrystalline Cellulose, NF (Ceolus) 108.701 mgCroscarmellose Sodium, NF (Ac-di-sol) 35.079 mg Lake Blend # LB-1617(Blend of D&C Yellow # 10 0.080 mg and FD&C Red # 40) MagnesiumStearate, NF 1.018 mg

[0299] Levoxyl ® 137 mcg Tablets Color: dark blue; Markings: (front)dp/137 (back) LEVOXYL ® Component Quantity in mg/Tablet LevothyroxineSodium, USP 0.137 mg β- Form Microcrystalline Cellulose, NF (Ceolus)108.288 mg Croscarmellose Sodium, NF (Ac-di-sol) 35.079 mg FD&C Blue # 10.478 mg Magnesium Stearate, NF 1.018 mg

[0300] Levoxyl ® 150 mcg Tablets Color: blue; Markings: (front) dp/150(back) LEVOXYL ® Quantity in mg/ Component Tablet Levothyroxine Sodium,USP 0.150 mg β- Form Microcrystalline Cellulose, NF (Ceolus) 108.645 mgCroscarmellose Sodium, NF (Ac-di-sol) 35.079 mg Lake Blend # LB-1612(Blend of D&C Red # 30 and 0.108 mg FD&C Blue # 1) Magnesium Stearate,NF 1.018 mg

[0301] Levoxyl ® 175 mcg Tablets Color: turquoise; Markings: (front)dp/175 (back) LEVOXYL ® Quantity in mg/ Component Tablet LevothyroxineSodium, USP 0.175 mg β- Form Microcrystalline Cellulose, NF (Ceolus)108.397 mg Croscarmellose Sodium, NF (Ac-di-sol) 35.079 mg Lake Blend #LB-334 (Blend of D&C Yellow # 10, 0.334 mg and FD&C Blue # 1) MagnesiumStearate, NF 1.018 mg

[0302] Levoxyl ® 200 mcg Tablets Color: pink; Markings: (front) dp/200(back) LEVOXYL ® Quantity in mg/ Component Tablet Levothyroxine Sodium,USP 0.200 mg β- Form Microcrystalline Cellulose, NF (Ceolus) 108.515 mgCroscarmellose Sodium, NF (Ac-di-sol) 35.079 mg Lake Blend # LB-1613(Blend of D&C Yellow # 10 0.188 mg and D&C Red # 30) Magnesium Stearate,NF 1.018 mg

[0303] Levoxyl ® 300 mcg Tablets Color: green; Markings: (front) dp/300(back) LEVOXYL ® Quantity in mg/ Component Tablet Levothyroxine Sodium,USP 0.300 mg β- Form Microcrystalline Cellulose, NF (Ceolus) 108.451 mgCroscarmellose Sodium, NF (Ac-di-sol) 35.079 mg Lake Blend # LB-1614(Blend of FD&C Yellow # 6, 0.142 mg D&C Yellow # 10 and FD&C Blue # 1)Magnesium Stearate, NF 1.018 mg

[0304] While the present invention has been described in the context ofpreferred embodiments and examples, it will be readily apparent to thoseskilled in the art that other modifications and variations can be madetherein without departing from the spirit or scope of the presentinvention. For example, the active moiety levothyroxine sodium can bechanged to liothyronine sodium and similar products and still beconsidered as part of the claimed invention. Accordingly, it is notIntended that the present invention be limited to the specifics of theforegoing description of the preferred embodiments and examples, butrather as being limited only by the scope of the invention as defined Inthe claims appended hereto.

Having described our invention, we claim:
 1. An immediate releasepharmaceutical composition comprising a levothyroxine salt, wherein thecomposition features a triiodothyronine (T3) AUC (0-t) of between fromabout 10 ng-hour/mlL to about 100 ng-hour/mlL
 2. The composition ofclaim 1, wherein the composition features a triiodothyronine (T3) AUC(0-t) of between from about 20 ng-hour/ml to about 60 ng-hour/ ml. 3.The composition of claims 1, wherein the In[AUC(0-t)] is between fromabout 1 to about
 5. 4. The composition of claims 2, wherein theIn[AUC(0-t)] is between from about 1 to about
 5. 5. The composition ofclaims 2, wherein the In(Cmax) of the levothyroxine (T4) plasma level isbetween from about 1 to about 3.